Risk of acute stroke in young patients with new-onset lupus nephritis: a case series (P9-5.028)

Abstract

<h3>Objective:</h3> To investigate the relationship between new-onset lupus nephritis and acute stroke. <h3>Background:</h3> Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease associated with an increased risk for stroke. <h3>Design/Methods:</h3> We reviewed medical records of patients evaluated by the inpatient Stanford Stroke Service from 2020–2022 with confirmed stroke on neuroimaging and diagnosis of SLE based on American College of Rheumatology Classification Criteria. Data regarding the clinical course, laboratory testing, and neuroimaging were extracted from electronic medical records. <h3>Results:</h3> Three patients were identified (two male, one female) with ages ranging from 17–32 years. Two patents had prior diagnosis of SLE without renal involvement. Magnetic resonance imaging obtained for all three patients demonstrated ischemic strokes restricted to a vascular territory. Magnetic resonance angiography demonstrated a proximal left superior cerebellar artery thrombus for one patient and slight enhancement in the proximal left M1-segment for another patient. Initial preliminary labs for all three patients were notable for leukopenia, anemia, hematuria, proteinuria, elevated urine protein/creatine ratio. Serologic testing was notable for positive ANA, positive anti-dsDNA, positive anti-Sm, low C3, and low C4. Anti-phospholipid labs and hypercoagulable work-up was negative. CSF analysis yielded normal protein, glucose, WBC, and RBC. All three patients were diagnosed with new-onset lupus nephritis, with two patients undergoing confirmatory renal biopsy. Patients were initially treated with a combination of prednisone, mycophenolate mofetil, and/or hydroxychloroquine and closely followed as an outpatient. One patient with vessel enhancement on initial imaging continued to have reoccurring strokes and required escalation of immunotherapy to cyclophosphamide with eventual remission and normalization of antibody levels. <h3>Conclusions:</h3> This case series presents several young patients with acute stroke in the setting of new-onset lupus nephritis without other traditional SLE-related stroke risk factors. Further research is needed to guide the stratification of stroke risk among patients with SLE. <b>Disclosure:</b> Dr. Wu has nothing to disclose. Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Han has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arena Pharmaceuticals. Dr. Lee has nothing to disclose.