Abstract: TH-PO661
Is It Rhabdomyolysis or Is It Lupus? A Case of Dual Presentation of New-Onset Lupus
Session Information
- Glomerular Diseases: Epidemiology and Case Reports
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Tahir, Hira, Stony Brook University Hospital, Stony Brook, New York, United States
- Daccueil, Farah, Stony Brook University Hospital, Stony Brook, New York, United States
Introduction
Acute kidney injury in unconscious patients has a wide range of differential diagnoses; rhabdomyolysis is a common consequence. However, acute lupus nephritis is rarely the most common presentation of an unconscious patient. Here we report diagnosis of lupus nephritis with severe rhabdomyolysis.
Case Description
A 40-year-old male with no medical history presents after being found down. Per a friend, for past few weeks, patient had been feeling ill with several Urgent Care visits for fever, prescribed multiple rounds of antibiotics with no improvement. On admission his speech was slurred, and he had bruising over his arms, dry mouth and lips, with blue extremities. Social history was noted for smoking 20 pack years, occasional marijuana uses and micro-dosing mushrooms. Physical exam was significant for bilateral lower extremity reticular rash and severe cyanosis of fingers and toes. Admissions labs had severe electrolyte abnormalities: Na 116 mmol/L, K 6.2 mmol/L, Cl 79 mmol/L, HCO3 16 mmol/L, BUN 105 mg/dL and Cr 3.26 mg/dL, calcium 6.8 mg/dL, albumin 1.9 g/dL, PO4 10.0 mg/dL, CPK 6533 IU/L, uric acid 12.3 mg/dL, urinalysis with large blood, 1 RBC, 100 protein, trace LE, negative nitrites and 1 WBC, urine Pr/Cr 0.41 g/dL and negative urine culture. Urine drug screen was positive for cannabinoids only. Blood gas showed pH 7.17, pCO2 46.1 mmHg, pO2 33 mmHg and HCO3 17 mEq/L. US revealed bilateral DVTs. CT was grossly unremarkable. Due to worsening electrolytes and creatinine, renal replacement therapy was started. Additional labs including C3, C4, ANA, anti-dsDNA, SM/RNP Ab and chromatin Ab were consistent with Lupus. Pulse dose steroids were initiated, and renal biopsy results revealed acute tubular injury with myoglobin casts and class II lupus nephritis. After pulse dose steroids and 2 weeks of intermittent hemodialysis, kidney function improved substantially. Due to severe digit necrosis, patient required fingertip amputations. The patient was started on low dose mycophenolate and discharged with close outpatient follow-up.
Discussion
Rhabdomyolysis is known to occur in unconscious patients with severe AKI (1). Few case reports diagnose new-onset lupus with concomitant rhabdomyolysis with renal failure requiring dialysis. Additionally, the widespread skin involvement and digit amputation made diagnosis and management for this case difficult and thought provoking.