Case 2. Systemic Lupus Erythematosus
a. Type III Autoimmune Reaction
Fluorescent antinuclear antibody testing was positive at a titer of 1:640 homogenous pattern and anti-dsDNA antibodies were detected at a titer of 1:160 using the Crithidia luciliae kinetoplast staining assay. Complement components C3 and C4 were low (56 and 11 mg/dl, respectively). She was treated with a high dose of methylprednisolone (another corticosteroid) intravenously followed by prednisone. A renal biopsy was performed and showed proliferative lupus nephritis. Immunofluorescence showed staining of the glomerular basement membrane for IgG as well as IgM and C3. She was treated with mycophenolate mofetil and after four months, her proteinuria and hematuria resolved, creatinine returned to near baseline (1.1 mg/dl). C3 increased to 85 mg/dl and anti-dsDnA antibodies decreased to 1;20
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