Renal Thrombotic Microangiopathy Revealing Systemic Lupus Erythematosus in a Young Woman: A Case Report

Abstract

Background: Thrombotic microangiopathy (TMA) is a rare but severe manifestation of systemic lupus erythematosus (SLE), frequently associated with antiphospholipid syndrome (APS). Early recognition is crucial, as it significantly influences renal and overall prognosis (George & Nester, 2014, Gómez-Puerta & Cervera, 2014). Case Presentation: We report the case of a 37-year-old woman with no prior medical history who presented with a multisystemic disease combining polyserositis, neurological involvement, arthritis, and renal impairment. Initial manifestations included inflammatory polyarthralgia, exudative pleuritis, pericardial tamponade requiring urgent drainage, and generalized seizures. Laboratory investigations revealed lymphopenia, microcytic anemia with elevated ferritin levels, prolonged activated partial thromboplastin time, and positive antiphospholipid antibodies. Immunological testing confirmed the diagnosis of SLE. Renal involvement was characterized by hypertension, active urinary sediment, and proteinuria ranging from 1.68 to 2.6 g/day. Kidney biopsy demonstrated class IV lupus nephritis associated with thrombotic microangiopathy. Immunofluorescence showed deposits of C3, C1q, IgG, and IgA. The patient was treated with high-dose corticosteroids, mycophenolate mofetil, hydroxychloroquine, and angiotensin-converting enzyme inhibitors, resulting in favorable clinical and biological outcomes. Conclusion: TMA may reveal SLE and should be suspected in patients presenting with severe or atypical renal involvement. Early diagnosis based on histological findings and prompt immunosuppressive therapy are essential to improve outcomes.