Lupus Flare in Peritoneal Dialysis: A Case Report

Introduction: In end-stage chronic renal failure patients undergoing renal replacement therapy, signs of lupus activity are frequently significantly decreased, with clinical, biological, and immunological improvement. However, lupus flares can still occur, particularly in patients on peritoneal dialysis. Case Presentation: We report the case of a 44-year-old female patient on peritoneal dialysis for one year with indefinite nephropathy. She had a history of parotitis associated with episodes of hypertension and dilated left cardiomyopathy with low left ventricular ejection fraction (26%). During follow-up, the patient presented with fever, myalgia, and arthralgia associated with pulmonary involvement. Laboratory findings showed an accelerated erythrocyte sedimentation rate at 100 mm at the first hour, negative C-reactive protein, low C3 and C4 complement levels, antinuclear antibodies at 1/1000, positive anti-DNA antibodies, negative c-ANCA, and inflammatory anemia with leukopenia. The diagnosis of lupus was established, and oral corticosteroid therapy was initiated at 0.5 mg/kg/day. After 3 months, a progressive tapering was started to reach 5 mg/day. The clinical course was marked by the occurrence of cough, dyspnea, and wheezing associated with unexplained fever. Chest CT scan revealed diffuse infiltrative pulmonary disease. After appropriate antibiotic treatment for ten days, with no signs of active lupus and negative lupus serology, the patient felt well on 5 mg of corticosteroids. Discussion and Conclusion: Lupus flares are rare in dialysis but appear to be more common in peritoneal dialysis than in hemodialysis. The possibility of lupus flares in peritoneal dialysis requires rigorous clinical, biological, and immunological monitoring. Recent meta- analyses confirm that lupus activity does not universally "burn out" in end- stage renal disease and that patients on both hemodialysis and peritoneal dialysis remain at risk for disease flares.