Abstract: SA-PO1278
Howling at the Wrong Wolf: Lymphomatous Renal Infiltration Behind the Face of Lupus Nephritis!
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Rodriguez Rivera, Carolina Isabel, Methodist Health System, Dallas, Texas, United States
- Sudheer, Namitha, Methodist Health System, Dallas, Texas, United States
- Goycochea, Carlos J., Methodist Health System, Dallas, Texas, United States
- Sebastian, Lisa M., Dallas Nephrology Associates, Dallas, Texas, United States
- Pariti, Sreevalli, Dallas Nephrology Associates, Dallas, Texas, United States
Introduction
Systemic Lupus Erythematous (SLE) is a chronic autoimmune disease that can affect kidneys causing lupus nephritis (LN). Patients with SLE on chronic immunosuppression are at an increased risk of infectious and malignant disorders. Diffuse Large B-cell Lymphoma (DLBCL) is an aggressive non-Hodgkin Lymphoma that rarely involves kidneys. This case highlights the clinical importance of maintaining malignant infiltration in differential diagnosis in patients with chronic immunosuppression.
Case Description
A 73-year-old female with past medical history of HTN, SLE, and CKD stage II.She had a kidney biopsy 20 years prior that showed class II LN for which she only received Prednisone and was in remission. She has been taking Hydroxychloroquine and Mycophenolate for about a year for systemic SLE exacerbation. She was being evaluated by her nephrologist for active urinary sediment with low C4 and low/normal C3 levels and was referred for a new kidney biopsy suspecting active LN. The day of the biopsy, she reported left-sided neck swelling, sore throat, and upper respiratory tract symptoms. Labs showed a creatinine of 2.7 mg/dL compared to a baseline of 0.9-1.1 mg/dL, and new-onset hypercalcemia with a calcium level of 12.8 mg/dL. Further evaluation demonstrated parathyroid hormone
(PTH)-independent hypercalcemia with elevated 1,25-dihydroxyvitamin D levels (> 200 ng/mL). Her kidney biopsy revealed mild focal proliferative LN class III and an overwhelming diffuse large B-cell lymphoma infiltration. The patient evaluated by hematology-oncology and initiated on R-CHOP chemotherapy.
Discussion
This case illustrates the importance of maintaining a broad differential diagnosis in patients with SLE who present with worsening renal function. Although lupus nephritis flare remains a major concern, malignant processes should also be considered, especially in patients receiving chronic immunosuppressive therapy. Early recognition and kidney biopsy are essential in diagnosis and treatment guidance.