Successful treatment of an adolescent with lupus nephritis and secondary thrombotic microangiopathy using eculizumab and belimumab

Childhood systemic lupus erythematosus (cSLE) is associated with a higher prevalence of lupus nephritis (LN) than adult-onset SLE [1]. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and multiple ischemic tissue damage. Active LN combined with concomitant TMA is a rare complication of cSLE and can lead to severe renal injury with extremely high morbidity and mortality. Pericarditis is a common cardiac manifestation in cSLE patients; however, only cases of TMA caused by hemolytic uremic syndrome (HUS) or atypical HUS (aHUS) with pericardial involvement have been reported in children [2].