DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.092

Pages: 1246-1248

Lupus extra membranous glomerulonephritis [EMG], corresponding to class V lupus nephritis, is usually revealed by nephrotic syndrome. Gastrointestinal manifestations of Systemic Lupus Erythematosus [SLE] are rare but are now better characterized in recent guidelines, and are exceptionally inaugural, potentially delaying diagnosis. We report the case of a 27-year-old woman initially hospitalized for a febrile digestive syndrome characterized by diarrhea, abdominal pain, and general deterioration. Abdominal computed tomography scan showed inflammatory ileitis, initially suggestive of an infectious etiology, but an extensive microbiological workup proved negative. The clinical course was marked by the subsequent development of generalized edema revealing severe nephrotic syndrome, leading to transfer to our nephrology department. Laboratory investigations demonstrated profound hypoalbuminemia, massive proteinuria, and microscopic hematuria. Immunological testing revealed severe hypocomplementemia, positive antinuclear antibodies, weakly positive anti-dsDNA antibodies, and positive anti-SSA and anti-RNP antibodies, suggesting active systemic lupus disease. The patient also presented with moderate pericardial effusion and inflammatory myositis on thigh MRI. Kidney biopsy confirmed lupus membranous nephropathy with IgG1, IgG2, and C1q deposits, allowing differentiation from primary membranous nephropathy. Treatment combining corticosteroids, mycophenolate mofetil, and hydroxychloroquine led to a favorable outcome, with regression of digestive manifestations and significant reduction in proteinuria.