Abstract
RATIONALE: Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects various organs. Disease activity in SLE may diminish following the initiation of dialysis in patients with end-stage renal disease. PATIENT CONCERN: We report the case of a 69-year-old female patient with a prior diagnosis of IgA nephropathy who developed SLE characterized by severe thrombocytopenia after hemodialysis. DIAGNOSES: The patient presented with fever, rash, polyarthralgia, thrombocytopenia, hemolytic anemia, positive antinuclear antibodies, anti-nucleosome antibodies, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and decreased complement C3 and C4 levels. She was diagnosed with SLE complicated by hematological damage and immune thrombocytopenia. INTERVENTIONS: The treatment included an intravenous infusion of 5% human immunoglobulin at 20 g/day for 5 days combined with an intravenous infusion of methylprednisolone at 500 mg/day for 3 days. Plasma exchange therapy was conducted a total of 3 times. OUTCOMES: The patient was discharged with methylprednisolone and hydroxychloroquine treatment. The platelet count was stable, antinuclear antibody, anti-nucleosome antibody, antiphospholipid antibody, Coombs test, and complement C3 and C4 levels were normal after discharge. LESSONS: In patients with unexplained thrombocytopenia, the possibility of SLE should be considered even after hemodialysis initiation.