Isolated renal dysfunction as the first sign of systemic lupus erythematosus (SLE) is rare (<5%) and prone to misdiagnosis as primary chronic kidney disease (CKD), especially when classic features are absent and competing etiologies complicate the picture. This case describes a 37-year-old man with five years of isolated CKD on hemodialysis who lacked typical lupus stigmata. Only later did positive ANA/anti–dsDNA, thrombocytopenia, and polyserositis reveal underlying SLE amid progressive multi-organ involvement.
Despite broad supportive care, infections, cardiovascular disease, and metabolic derangements precipitated septic shock, cerebral hemorrhage, and death. This illustrates the bidirectional worsening between uncontrolled infection and active SLE and the peril of initiating immunosuppression in sepsis. Key lessons are to maintain high suspicion for SLE in patients with CKD with unexplained multisystem decline and incorporate early rheumatologic serology, even when titers are low. Researchers also urge engaging multidisciplinary teams early to balance infection control with timely immunomodulation and to address organ-specific complications. Imaging documented polyserositis and splenic infarcts, underscoring systemic immune-complex injury and the value of early immunologic workup and, when feasible, tissue biopsy to prevent such escalation.
Reference: Li Z, Yang K. Systemic Lupus Erythematosus Presenting Primarily With End-Stage Renal Disease in Men: A Case Report. Cureus. 2025;17(8):e91216. doi: 10.7759/cureus.91216.
