Sun-Induced Life-Threatening Lupus Nephritis

Authors: SCHMIDT, ENNO¹; TONY, HANS-PETER²; BRÖCKER, EVA-BETTINA¹; KNEITZ, CHRISTIAN²

Source: Annals of the New York Academy of Sciences, Volume 1108, Number 1, June 2007 , pp. 35-40(6)

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Abstract:

Photosensitivity is a widely known characteristic of both cutaneous and systemic lupus erythematosus (LE). However, sun-induced organ involvement is rarely reported in LE. We describe a 34-year-old woman who had been in complete remission of systemic LE for more than 8 years without treatment. After sunbathing, she developed acute sunburn followed by cutaneous LE in sun-exposed areas. Six weeks later, a lupus nephritis was diagnosed and high serum levels of anti-double-stranded (ds) DNA and anti-Ro/SSA antibodies were detected. Treatment with systemic cyclophosphamide and prednisolone led to septicemia requiring assisted ventilation for more than 2 weeks and repeated hemodialysis. Clinical remission was achieved 3 months later by the use of prednisolone and mycophenolate mofetile. Meanwhile, mild proteinuria persisted, anti-dsDNA antibodies normalized. We hypothesize that the sunburn-induced keratinocyte necrosis/apoptosis exposed intracellular antigens as trigger for the generation of autoantibodies that finally mediated immune-complex nephritis. The patient highlights the impact of UV light not only on skin but also on internal organ involvement in LE.

Keywords: autoantibody; dsDNA; lupus erythematosus; nephritic syndrome; photosensitivity; Ro/SSA; skin; UV light

Document Type: Research article

DOI: http://dx.doi.org/10.1196/annals.1422.004

Affiliations: 1: Department of Dermatology, University of Würzburg, Würzburg, Germany 2: Department of Internal Medicine, University of Würzburg, Würzburg, Germany

Publication date: 2007-06-01