Lupus nephritis - case report of an uncommon succession of therapies

Background. Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE) and often occurs within the first five years after diagnosis. Case report. A 33-year-old woman with SLE (arthritis; cutaneous involvement; Raynaud phenomena, vasculitis, pleural effusion, hematological and immunological abnormalities), under treatment with glucocorticoids and hydroxychloroquine developed focal proliferative LN, which progressed under treatment with belimumab. Consequently, intravenous cyclophosphamide and low-dose rituximab were used to induce LN remission, while maintenance therapy relied on mycophenolate mofetil. Conclusions. The case illustrates an uncommon succession of therapies for SLE and LN, with belimumab preceding cyclophosphamide. The decision to induce remission with cyclophosphamide was based on histological aspects of the renal biopsy. Although current recommendations permit the association of belimumab and cyclophosphamide, there is very little practical experience to support it.