Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 707-713
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.707
Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report
Zi-Gan Xu, Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan
Zi-Gan Xu, Wei-Long Li, Xi Wang, Shu-Yuan Zhang, Ying-Wei Zhang, Xing Wei, Chun-Di Li, Ping Zeng, Shao-Dong Luan, Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
Author contributions: Xu ZG reviewed the literature and contributed to manuscript drafting; Li WL, Wang X, Zhang SY, Zhang YW, Li CD, and Zeng P collected the information from the patient; Wei X and Luan SD were surgeons for biopsy and revised the manuscript; Luan SD supervised the study; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shao-Dong Luan, PhD, Chief Doctor, Department of Nephrology, Shenzhen Longhua District Central Hospital, No. 187 Guanlan Road, Shenzhen 518110, Guangdong Province, China. szkidney3@163.com
Received: September 15, 2020
Peer-review started: September 15, 2020
First decision: November 14, 2020
Revised: November 23, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 26, 2021
Processing time: 126 Days and 22.2 Hours
Abstract
BACKGROUND

Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are classically thought to cause renal impairment and small vessel vasculitis with different pathophysiologies. Their overlap constitutes a rare rheumatologic disease. To date, only dozens of such cases with biopsy-proven glomerulonephritis have been reported worldwide typically in women of childbearing age. Here, we present a unique clinical case due to its rarity and individualized treatment of a Chinese man in his eighth decade of life.

CASE SUMMARY

A 77-year-old man was admitted to several hospitals for shortness of breath and received nonspecific treatments over the past 3 years. As his symptoms were not completely relieved, he visited our hospital for further treatment. Laboratory examinations revealed kidney dysfunction, severe anaemia, hypocom-plementemia, glomerular proteinuria, and microscopic haematuria. Antinuclear antibodies, as well as anti-dsDNA antibodies, were positive. Computed tomography of the chest showed right pleural effusion. Renal biopsy was performed, and histology suggested crescentic glomerulonephritis, pauci-immune type. After treatment with plasmapheresis, glucocorticoid, and cyclo-phosphamide, the disease was in remission, and the patient remained in a stable condition for over 3 years post-hospital discharge.

CONCLUSION

Due to its complexity and rarity, SLE and AAV overlap syndrome is easily misdiagnosed. An accurate diagnosis and treatment at the earliest stage may significantly improve the condition and reduce irreversible organ injury.

Keywords: Systemic lupus erythematosus; Antineutrophil cytoplasmic antibody-associated vasculitis; Overlap syndrome; Elderly male; Renal insufficiency; Case report

Core Tip: Systemic lupus erythematosus and associated vasculitis overlap syndrome was first described in 1997, and only dozens of such cases have been reported to date worldwide. We report an elderly male patient who was not diagnosed with this disease in a timely manner due to hidden features. After treatment with plasmapheresis, glucocorticoid, and cyclophosphamide, the patient’s condition improved, even at his advanced age.