Seronegative Lupus Nephritis Revealing Male Lupus: A Case Report and Literature Review
Abstract
The diagnosis of systemic lupus erythematosus (SLE) classically relies on the association of clinical manifestations with positive serological tests, particularly antinuclear antibodies (ANA) and anti-dsDNA antibodies. Seronegative lupus is a rare entity characterized by negative immunological markers despite characteristic clinical features. Its prevalence is estimated between 2% and 10% of all lupus cases, with a higher frequency observed in male patients. We report the case of a 55-year-old man who presented with an isolated renal manifestation of lupus, in the absence of any other clinical or biological signs of systemic disease. The diagnostic work-up ruled out other etiologies, and the renal biopsy revealed a class IV proliferative glomerulonephritis with a characteristic "full-house" immunofluorescence pattern. This case highlights the diagnostic challenges of seronegative lupus and the central role of renal biopsy in establishing the diagnosis. A review of the literature on seronegative lupus and male lupus is presented.
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- References
- Yeboah, E.K., et al., A Rare Case of Seronegative Lupus Nephritis Presenting as Immune Complex Diffuse Glomerulonephritis. Cureus, 2025. 17(6): p. e86406.
- Aringer, M., et al., 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis, 2019. 78(9): p. 1151–1159.
- Petri, M., et al., Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum, 2012. 64(8): p. 2677–86.
- Maddison, P.J., T.T. Provost, and M. Reichlin, Serological findings in patients with "ANAnegative" systemic lupus erythematosus. Medicine (Baltimore), 1981. 60(2): p. 87–94.
- Araujo, F., I.V.S. Lima, and M.B. Santiago, Clinical Characteristics of Antinuclear AntibodyNegative Systemic Lupus Erythematosus: A Systematic Review. J Clin Rheumatol, 2025. 31(7): p. 275–278.
- Gladman, D.D., A. Chalmers, and M.B. Urowitz, Systemic lupus erythematosus with negative LE cells and antinuclear factor. J Rheumatol, 1978. 5(2): p. 142–7.
- Weening, J.J., et al., The classification of glomerulonephritis in systemic lupus erythematosus
- revisited. Kidney Int, 2004. 65(2): p. 521–30.
- Hanly, J.G., et al., The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford), 2016. 55(2): p. 252–62.
- Uzzo, M., et al., Nonlupus Full House Nephropathy: A Systematic Review. Clin J Am Soc Nephrol, 2024. 19(6): p. 743–754.
- Wen, Y.K. and M.L. Chen, Clinicopathological study of originally non-lupus "full-house" nephropathy. Ren Fail, 2010. 32(9): p. 1025–30.
- Fanouriakis, A., et al., 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis, 2019. 78(6): p. 736–745.
- Chow, J., M.N. Achuko, and X.L. Chen, An Unusual and Rare Case of a Seronegative Male Patient With Lupus Nephritis. Cureus, 2020. 12(8): p. e9739.
- Mima, A., et al., A Case of Seronegative Lupus Nephritis Detected Incidentally by Renal Biopsy.
- In Vivo, 2025. 39(4): p. 2328–2332.
- Rees, F., et al., The incidence and prevalence of systemic lupus erythematosus in the UK, 19992012. Ann Rheum Dis, 2016. 75(1): p. 136–41.
- Murphy, G. and D. Isenberg, Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology (Oxford), 2013. 52(12): p. 2108–15.
- Lau, C.S., G. Yin, and M.Y. Mok, Ethnic and geographical differences in systemic lupus erythematosus: an overview. Lupus, 2006. 15(11): p. 715–9.