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LP-126 The infectious complication in multitarget therapy of class V lupus nephritis: a case report
  1. Tatiana Panafidina,
  2. Tatiana Popkova,
  3. Anastasiia Shumilova and
  4. Aleksandr Lila
  1. Systemic lupus erythematosus, V.A.Nasonova Research Institute of Rheumatology, Moscow, Russian Federation, Russian Federation


Description Agents such as cyclosporine A(CSA) and tacrolimus(TAC) have long been used in SLEpatients. A new therapeutic approach of lupus nephritis(LN) is a multitarget therapy: calcineurin inhibitors with mycophenolate mofetil(MMF).

Here is a case report of lupus nephritis (class V) and infectious complication in a SLE patient treated with low-dose combination of CSA and MMF.

A 40-year-old woman(caucasoid), the disease debut at the age of 25, duration 16 years(since 2006), the diagnosis of SLE was established in 10.2011(full picture after childbirth). History: LN (class IV, with nephrotic syndrome, azotemia – 2011), nervous system (migraine with aura, sensorimotor polyneuropathy of the lower extremities, dysuria – 2011), arthritis and Raynaud’s phenomenon (2006, 2010), thrombocytopenia (2011), positive anti-ds-DNA, anti-Sm, ANA, hypocomplementemia (2011). In 2011, therapy was carried out with high doses of prednisolone(max 40mg/day), cyclophosphamide (total 5000mg, 2011–2012years), rituximab (1000 mg No. 2, 2012–2013years), MMF 2.5–1 g/day (2012 -2017years), hydroxychloroquine(HCQ). Low disease activity was achieved in 2016–12.2020years: therapy with prednisolone 5mg/day and HCQ 200mg/day.

In 12.2020 there was a disease relapse – isolated persistent proteinuria 1.3g/day. Repeated nephrobiopsy was performed: membranous glomerulonephritis(class V) was revealed. The dose of prednisolone was increased from 5 to 30mg/day, MMF 2 g/day was added, HCQ. After 5 months of this therapy, proteinuria did not decrease – 1.2g/day. A decision was made to switch to multitarget therapy: a combination of MMF 1g/day and CSA 150mg/day (2 mg/kg/day) from 06/14/2021, but on 07/16/2021 panaritium of the 2nd toe of the foot developed. Resumption of multitarget therapy 08/12/2021. By September 2021 proteinuria decreased to 0.6g/day, but on 09/28/2021, purulent bursitis of the right elbow joint developed. The patient was transferred to monotherapy of MMF 1–2 g/day, prednisone10–7.5mg/day, HCQ 200mg/day, proteinuria 0.18 g/day from 03.2022

Conclusions Multitarget therapy with CSAandMMF is effective in treating LN(classV), but can lead to purulent infectious complications.

  • SLE
  • multitarget therapy
  • infectious complications

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