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Yang, Hong, Lim, Jang, Jeon, and Yoo: A Case of ANA-negative, Anti-dsDNA Negative, and Anti-Ro/SSA Positive Membranous Lupus Nephropathy
Case Report

J Rheum Dis 2013;20(2):127-131.

Published online: 31 April 2013

DOI: https://doi.org/10.4078/jrd.2013.20.2.127

A Case of ANA-negative, Anti-dsDNA Negative, and Anti-Ro/SSA Positive Membranous Lupus Nephropathy

Hee-Chan Yang, Myong-Joo Hong, Jin-Han Lim, Seol-A Jang, So-Yeon Jeon, Wan-Hee Yoo

Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and The Research Institute of Clinical Medicine, Jeonju, Korea

Corresponding to : Wan-Hee Yoo, Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and The Research Institute of Clinical Medicine, 20, Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. E-mail : ywhim@jbnu.ac.kr

Received 27 March 201229 April 2012       Accepted 22 May 2012

Copyright © 2013 The Korean College of Rheumatology

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of diverse autoantibodies with various systemic organ involvements. In patients with SLE, autoantibodies, such as antinuclear antibody (ANA) and anti-dsDNA antibody, play an important role not only in diagnosing the disease, but also representing the pathogenesis of the disease. ANA is the main screening tool in diagnosis and serum complement levels and anti-dsDNA antibody level are closely related to the disease activities. Nevertheless, exceptionally, some patients represent with negative ANA and/or anti-dsDNA antibody leading to diffi-culties in diagnosing the disease. Here, we report a case of 37-year old female SLE patient with negative ANA, negative anti-dsDNA antibody, and positive anti-Ro/SSA antibody, which manifested with nephrotic syndrome.

Keywords: Antinuclear antibody (ANA), Anti-dsDNA antibody, Anti-Ro antibody, Membranous nephropathy, Systemic lupus erythematosus

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Figure 1.
Pathologic findings of renal biopsy showed lupus nephritis, class V.
jrd-20-127f1.tif
Figure 2.
Immunofluorescence findings of renal biopsy.
jrd-20-127f2.tif
Table 1.
Comparative analysis of ANA negative lupus nephrits (8–15)
Case 1 (8) 2 (9) 3 (10) 4 (11) 5 (12) 6 (13) 7 (14) 8 (15) Our case
Age 13 30 51 16 22 10 44 5 month 37
Sex M F M F F F F F F
Rash (malar/discoid) (+) (+) : malar (-) (+) : malar (+) : malar (-) (-) (-) (+) : malar
Photosensitivity (-) (-) (-) (+) (+) (-) (-) (-) (-)
Oral ulcer (-) (-) (-) (-) (+) (-) (-) (-) (-)
Arthritis (+) (+) (-) (+) (+) (-) (-) (-) (-)
Renal d/o (+) IV (+) (+) IV (+) III (+) I (+) III (-) (+) V (+) V
Pleuritis/pericarditis (+) (+) (-) (+) (-) (-) (+) (-) (-)
Neurologic d/o (-) Seizure (-) (-) Seizure (-) (-) (-) (-)
Hematologic d/o Hemolytic anemia Lymphopenia, hemolytic anemia Lymphopenia Lymphopenia Thrombocytopenia (-) (-) Hemolytic anemia, thrombocytopenia Hemolytic anemia thrombocytopenia
Immunologic d/o dsDNA/Sm/aPL All (-) All (-) All (-) All (-) Not done (-/-/+) All (-) All (-) All (-)
ANA (-) (-) (-) (-) (-) (-) (-) (-) (-)
Number of succeptible criteria 5 6 2 6 7 2 1 2 3
 Autoantibodies                  
Ro U/K (+) (+) (-) (+) (-) (-) (-) (+)
La U/K (-) U/K (-) (-) (-) (-) (-) (-)
RNP U/K (-) U/K (-) U/K (-) (-) (-) (-)
ANCA (-) (-) U/K U/K U/K (-) (-) U/K (-)
Treatment Steroid pulse immunosuppressive agent Steroid pulse immunosuppressive agent, abortion Steroid PO MMF Steroid pulse immunosuppressive agent Steroid pulse Steroid pulse immunosuppressive agent Steroid Steroid pulse, IVIG, immunosuppressive agent Steroid pulse immunosuppressive agent
Others Vasculitis, peritonitis Pregnant HBV(+), CTS   Vasculitis Abdominal pain Anti-histone(+), lisinopril    

ANA: antinuclear antibody, ANCA: Anti-neutrophil cytoplasmic antibody, CTS: carpal tunnel syndrome, d/o: disorder, F: female, HBV: hepatitis B virus, IV: intravenous, IVIG: intravenous immunoglobulin, La: SS-B, M: male, MMF: mycofenolate mofetil, PO: per oral, RNP: ribonucleoprotein, Ro: SS-A, U/K: unknown

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