Abstract: SA-PO275
Drug Induced Lupus Nephritis in Psoriasis Secondary to Adalimumab Use
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Kaur, Gurleen, Emory, Decatur, Georgia, United States
- Bailey, James L., Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Adalimumab, an anti-Tumor necrotic factor α agent (anti-TNF α), is approved by the FDA for treatment of moderate to severe chronic plaque psoriasis.The drug is generally well-tolerated, however auto immunity with the development of systemic lupus erythematosus (SLE) is a rarely reported. We describe a case of Adalimumab being used for chronic plaque psoriasis in which the patient developed lupus nephritis.
Case Description
A 32 year-old-lady with refractory chronic plaque psoriasis had been on Adalimumab for 3 months and presented with a 3-day history of bilateral lower extremity swelling. On evaluation, she was found to have a malar rash and alopecia, hemoglobin 6.7g/dL, creatinine 0.6 mg/dL, albumin 1.5g/dL, UA 3+ protein and 50 RBCs. A spot urinary protein: creatinine ratio was 4.8g/g with microalbumin of >1g. Further work up for proteinuria revealed a positive ANA, SSA, Anti Ro, Anti La, RNP, Anti Smith (519 AU/mL), ds DNA (1257 IU/mL), anti-histone (>999 AU/mL) while other serological work up was negative. A renal biopsy was performed on day 3: focal proliferative glomerulonephritis with 1 focally sclerosed glomerulus and full house staining on immunofluorescence consistent with class III lupus nephritis was found. The adalimumab was stopped and she was started on Prednisone and Hydroxychloroquine. On follow up, she was started on cyclophosphamide. Subsequently, her proteinuria and other symptoms improved.
Discussion
"Anti-TNF α-induced lupus (ATIL)" is characterized by high prevalence of anti-dsDNA antibodies (>90%) and low prevalence of ant histone (57%) with respect to the classic form of SLE. The presence of SLE meeting the American college of rheumatology guidelines and concomitant exposure to lupus-inducing drug are widely accepted criteria for ATIL. There have been no cases reported in the literature of adalimumab induced lupus nephritis. In our case, the lupus nephritis improved after discontinuation of the drug, supporting the diagnosis of ATIL. Symptoms resolve within 3 weeks to 6 months after stopping the drug. Additional immunosuppressant medications may be required to achieve full remission.