# 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.

## Key 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.