Sun-induced life-threatening lupus nephritis

Ann N Y Acad Sci. 2007 Jun:1108:35-40. doi: 10.1196/annals.1422.004.

Abstract

Photosensitivity is a widely known characteristic of both cutaneous and systemic lupus erythematosus (LE). However, sun-induced organ involvement is rarely reported in LE. We describe a 34-year-old woman who had been in complete remission of systemic LE for more than 8 years without treatment. After sunbathing, she developed acute sunburn followed by cutaneous LE in sun-exposed areas. Six weeks later, a lupus nephritis was diagnosed and high serum levels of antidouble-stranded (ds) DNA and anti-Ro/SSA antibodies were detected. Treatment with systemic cyclophosphamide and prednisolone led to septicemia requiring assisted ventilation for more than 2 weeks and repeated hemodialysis. Clinical remission was achieved 3 months later by the use of prednisolone and mycophenolate mofetile. Meanwhile, mild proteinuria persisted, anti-dsDNA antibodies normalized. We hypothesize that the sunburn-induced keratinocyte necrosis/apoptosis exposed intracellular antigens as trigger for the generation of autoantibodies that finally mediated immune-complex nephritis. The patient highlights the impact of UV light not only on skin but also on internal organ involvement in LE.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Antinuclear / blood
  • Female
  • Humans
  • Lupus Nephritis / blood
  • Lupus Nephritis / etiology*
  • Lupus Nephritis / physiopathology
  • Photosensitivity Disorders / blood
  • Photosensitivity Disorders / physiopathology*
  • Sunburn
  • Sunlight / adverse effects*

Substances

  • Antibodies, Antinuclear