Korean J Intern Med.  2009 Mar;24(1):76-79. 10.3904/kjim.2009.24.1.76.

An Antinuclear Antibody-Negative Patient With Lupus Nephritis

• Kim HA
• Chung JW
• Park HJ
• Joe DY
• Yim HE
• Park HS
• Suh CH

• KMID: 1785647
• DOI: http://doi.org/10.3904/kjim.2009.24.1.76

Abstract

Systemic lupus erythematosus (SLE) is a typical autoimmune disease that's characterized by various autoantibodies to nuclear and cytoplasmic antigens. The presence of antinuclear antibodies (ANA) in serum is generally considered a decisive diagnostic sign of SLE. However, a small subset of SLE patients who had the typical clinical features of SLE was reported to show persistently negative ANA tests. Our report describes a 16-yr-old female who presented with the clinical manifestations of SLE such as malar rash, photosensitivity, arthritis, lymphopenia, pericarditis and proteinuria. The serum autoantibodies were all negative and renal biopsy showed that the histopathological changes of immune complex mediated the focal segmental necrotizing glomerulonephritis with crescent formation. She was treated with monthly pulse cyclophosphamide along with corticosteroids. During the 2-yr follow-up period, the proteinuria was markedly decreased and all of the ANA and anti-double stranded DNA antibody tests were negative. This case suggests that ANA may not be required in the pathogenesis of lupus nephritis.

Keyword

Antinuclear antibody; Lupus nephritis; Systemic lupus erythematosus

MeSH Terms

Adolescent
Antibodies, Antinuclear/*immunology
Biopsy
Female
Follow-Up Studies
Humans
Lupus Nephritis/diagnosis/*immunology
Tomography, X-Ray Computed