Acute lupus nephritis

Case contributed by Dr Hani Makky Al Salam

Presentation

Known case of SLE presented with acute shortness of breath.

Patient Data

Age: 25 years
Gender: Female
X-ray

Flask-shaped enlargement of the cardiac silhouette in keeping with pericardial effusion. The lungs are clear. 

CT

A huge large circumferential pericardial effusion is noted.

Mildly enlarged and increase in number of bilateral axillary lymph nodes and suggestion of increased number of mediastinal lymph nodes, however, evaluation is limited due to lack of IV contrast.  

The left lower lobe atelectasis is noted due to a small left sided pleural effusion. Small trace of right sided pleural fluid.  

No masses or consolidation is seen.  

Mild pulmonary edema.

Ultrasound

Transthoracic Echocardiogram

There is a large circumferential pericardial effusion with signs suggestive of early tamponade.

Structurally normal aortic, mitral, tricuspid and pulmonic valves with trace tricuspid and pulmonic regurgitation.

Normal chamber dimensions with normal right and left ventricular systolic function, estimated LV EF is 60-65%.

X-ray

Decreased amount of pericardial effusion after insertion of a drainage catheter. 

Ultrasound

Biopsy

US-guided renal biopsy.

CT

Left perinephric hematoma as a complication of renal biopsy

X-ray

After treatment

Normalization after treatment.

Case Discussion

Kidney biopsy: Lupus nephritis class IV-G (A).

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