Development of systemic lupus erythematosus in an elderly male hemodialysis patient with pleuritis

This report describes a 70-year-old man who developed systemic lupus erythematosus (SLE) during treatment with maintenance hemodialysis. At initiation of maintenance dialysis, the etiology of end-stage renal disease (ESRD) was diabetic nephropathy and no clinical symptom or laboratory data suggested SLE. Fever, pleural effusion that did not respond to ultrafiltration, and immunological findings such as low complement and elevated anti-double-strand DNA antibody level appeared 4 years after maintenance dialysis initiation. Immunosuppressive therapy with corticosteroids improved these abnormalities remarkably. This case underscores the necessity of considering SLE in the differential diagnosis of pleural effusion with male ESRD patients, even if another etiology of ESRD exists.