Epistaxis and Hypertensive Emergency as the First Signs of Lupus Nephritis

TL;DR

A 64-year-old woman with lupus nephritis first showed signs of severe nosebleeds and high blood pressure, which led to a successful treatment with steroids and cyclophosphamide.

Contribution

This case report highlights a rare initial presentation of lupus nephritis with hypertensive emergency and epistaxis.

Findings

The patient presented with epistaxis and severe hypertension as initial symptoms of lupus nephritis.

Renal biopsy confirmed diffuse proliferative lupus nephritis (Class IV).

Treatment with corticosteroids and cyclophosphamide resulted in a favorable clinical response.

Abstract

Systemic lupus erythematosus is a multisystem autoimmune disease that predominantly affects young females. This case report describes a rare presentation of a hypertensive emergency as the initial manifestation of lupus nephritis (LN) in a 64-year-old female with normal serum creatinine at presentation. The patient initially presented with epistaxis and severe hypertension (221/127 mmHg). Further evaluation revealed non-nephrotic range proteinuria and microscopic hematuria. Autoimmune studies and renal biopsy confirmed diffuse proliferative LN (Class IV). Treatment with corticosteroids and cyclophosphamide yielded a favorable clinical response.

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