This case report documents the rare appearance of in vivo ANA positivity in renal tissues of a lupus nephritis patient after 17 years of follow-up and treatment.
Suggests possible serum-transferable autoimmunity in refractory lupus nephritis; leaves open clinical relevance pending larger studies.
In vivo anti-nuclear antibody positive phenomenon in the renal tissues except for necropsy/autopsy cases or very severe cases of systemic lupus erythematosus is a controversial issue until today. However, we experienced a case of lupus nephritis that showed in vivo anti-nuclear antibody-positive cells in the renal tissues. Four successive renal biopsies over 17 years were studied with immunofluorescence as well as immunohistochemical and immuneelectron microscopic staining. The first, second and third biopsies did not reveal any in vivo anti-nuclear antibodypositive cells. However, the fourth biopsy in relapse showed positive cells, and the transfer of the patient's serum into the mice provoked in vivo anti-nuclear antibody-positive cells in the mouse intestines. We present this case in detail and discuss the implications of these observations.
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Nakabayashi et al. (2018) studied this question.
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