Abstract
RATIONALE: Although percutaneous renal biopsy is generally considered safe, it can result in complications such as sinus tract formation, particularly in immunocompromised patients. In systemic lupus erythematosus (SLE), prolonged immunosuppression impairs tissue repair, complicating management. No standardized treatment exists for post-biopsy sinus tracts in SLE, and conventional approaches often yield poor results. A case of a giant sinus tract after renal biopsy in an SLE patient, successfully managed with multidisciplinary therapy, offering a potential reference for similar complex cases. PATIENT CONCERNS: A 38-year-old woman with an 8-year history of SLE and lupus nephritis was admitted due to persistent redness and exudation at the renal biopsy site for 5 months. Prior treatments at an outside hospital, including intravenous antibiotics, abscess incision and drainage, and routine dressing changes, were ineffective, and her symptoms progressively worsened. Imaging revealed an irregular sinus tract measuring approximately 10 cm × 9 cm in the right lumbar region. DIAGNOSES: Giant sinus tract formation following percutaneous renal biopsy. INTERVENTIONS: Standard immunosuppressive therapy was initiated to control SLE. On day 5, the patient underwent debridement combined with negative pressure wound therapy with instillation using hydrogen peroxide. Medications were adjusted with the support of the nephrology department. On day 13, radical excision of the sinus tract, further debridement, and skin flap grafting were performed. Dual-mode negative pressure drainage was applied to accelerate healing, and systemic antibiotics were administered based on culture and sensitivity results. OUTCOMES: By day 40 of hospitalization, the wound was completely epithelialized, without redness or discharge. The patient achieved complete clinical healing and remained recurrence-free during a 4-year follow-up. LESSONS: Despite the relatively low post-procedural infection rate in SLE patients, clinicians should remain vigilant for complications such as sinus tract formation at the biopsy site. Early imaging is essential for timely diagnosis and preventing missed diagnoses. In this case, a combination of immunomodulation, negative pressure wound instillation therapy, and local skin flap reconstruction, along with dual-mode negative pressure drainage, demonstrated high debridement efficiency, minimal trauma, improved healing, better prognosis, and a low recurrence rate.