Rare Presentation of Lupus Nephritis with Aseptic Splenic Abscess: A Case Report

Rare Presentation of Lupus Nephritis with Aseptic Splenic Abscess: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rare Presentation of Lupus Nephritis with Aseptic Splenic Abscess: A Case Report surya prakash thotanolla This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7176528/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations. Although lupus nephritis is a common and severe manifestation, aseptic splenic abscess is extremely rare in SLE. Case Presentation: We present the case of a 25-year-old female with lupus nephritis who developed an aseptic splenic abscess. The diagnosis was confirmed by imaging, negative cultures, serological markers, and active lupus nephritis features. The patient responded well to drainage and immunosuppressive therapy. Conclusion: Aseptic splenic abscess is an uncommon but important differential diagnosis in SLE patients with unexplained abdominal pain and sterile collections. Early recognition and treatment are essential for optimal outcomes. Systemic lupus erythematosus aseptic abscess splenic abscess lupus nephritis autoimmune disease Figures Figure 1 Figure 2 Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder characterized by autoantibody production and immune complex deposition. Lupus nephritis is a frequent and severe complication [ 1 ]. The development of splenic abscesses, particularly sterile or aseptic abscesses, is extremely rare in SLE and can present diagnostic challenges. Case Presentation A 25-year-old woman presented with left hypochondrial abdominal pain and intermittent fever for one month. She also reported bilateral lower limb swellings. On admission her blood pressure was 130/90 mm of hg in right arm, pulse rate was 86/min, all peripheral pulses are felt equally on both sides. On examination, tenderness was noted over the left hypochondrium. Her lab reports are presented below in table (1). Table 1 Investigation Result Normal Range (where applicable) Hemoglobin 7.6 g/dL 12–16 g/dL Total Leukocyte Count 19,300 cells/cumm 4,000–11,000 cells/cumm Platelet Count 1.80 lakhs/cumm 1.5–4.5 lakhs/cumm Peripheral Smear Normocytic Normochromic RBCs — Serum Creatinine 1.47 mg/dL 0.6–1.3 mg/dL Blood Urea 36 mg/dL 15–40 mg/dL Sodium 130 mmol/L 135–145 mmol/L Potassium 3.6 mmol/L 3.5–5.0 mmol/L Total Protein 5.4 g/dL 6–8 g/dL Serum Albumin 2.0 g/dL 3.0–5.5 g/dL Total Bilirubin 0.75 mg/dL < 1.2 mg/dL Direct Bilirubin 0.25 mg/dL < 0.3 mg/dL AST (SGOT) 181 U/L 5–40 U/L ALT (SGPT) 35 U/L 5–45 U/L Alkaline Phosphatase 181 U/L 45–150 U/L Urine Albumin 3+ Negative to trace Urine Sugar Nil Nil RBCs (Urine) 1–2 /hpf 0–1 /hpf WBCs (Urine) Plenty/hpf 0–5 /hpf Epithelial Cells (Urine) 2–4 /hpf < 5 /hpf HIV, HBsAg, HCV ELISA Negative Negative Serum Cholesterol 155 mg/dL < 200 mg/dL Serum Triglycerides 346 mg/dL 40 mg/dL LDL Cholesterol 67 mg/dL < 100 mg/dL VLDL Cholesterol 69 mg/dL 5–40 mg/dL CT Abdomen Splenic abscess (12×13×10 cm) — C3 and C4 Complement Low ANA Profile Positive: dsDNA, Nucleosome, Histone, SS-A/Ro 60 & 52 kD ANA IgG (ELISA) > 500 IU/mL dsDNA Antibody > 800 IU/mL < 30 IU/mL 24-hour Urine Protein 2.3 g < 150 mg/day Blood and Urine Cultures No growth Sterile Anti-Cardiolipin Antibody Negative Negative CT abdomen revealed a 12x13x10 cm hypodense lesion (Fig. 1 )in the spleen suggestive of abscess. Empirical antibiotics were started, and ultrasound-guided drainage yielded 800 ml of fluid. Cultures and GeneXpert were negative. A diagnosis of aseptic splenic abscess associated with active SLE was made. The patient improved with drainage, antibiotics, and initiation of immunosuppressive therapy. CT scan of both axial(Fig. 1 ) and coronal view (Fig. 2 )showing splenic abcess. Discussion Splenic abscesses make up fewer than 1% of all intra-abdominal abscesses, making them a rare clinical condition. Most cases result from bacterial infections, with contributing variables such as immunosuppression, trauma, and hematogenous dissemination[ 2 ]. Aseptic abscesses, in contrast, are sterile, immune-mediated collections initially identified in relation to inflammatory bowel illness. [ 3 ]. Their prevalence in systemic lupus erythematosus (SLE) is exceedingly uncommon. [ 4 ]. The pathophysiology of aseptic abscesses in systemic lupus erythematosus is conjectural but may involve immune complex-mediated vasculitis, neutrophilic infiltration, and microvascular thrombosis. [ 4 ][ 5 ]. These processes can result in localized tissue necrosis and sterile abscess formation. Such abscesses may be associated with the hypercoagulable state observed in systemic lupus erythematosus (SLE), particularly in patients with antiphospholipid antibodies; however, this patient tested negative for anticardiolipin antibodies [ 5 ]. Clinically, aseptic abscesses closely mimic infectious ones, making differentiation challenging. Imaging studies such as CT or ultrasound typically reveal hypodense lesions, but these findings do not distinguish between septic and aseptic origins [ 2 ]. Therefore, microbiological testing is essential. In this case, repeated cultures and GeneXpert results were negative, and the lack of systemic signs of sepsis further suggested a non-infectious etiology. Management should be individualized. While initial treatment with empirical antibiotics and drainage is appropriate, early recognition of the abscess’s sterile nature should prompt timely initiation of immunosuppressive therapy to address the underlying autoimmune inflammation [ 4 ][ 6 ][ 7 ]. Delayed immunosuppression can lead to further organ damage and unnecessary antibiotic exposure. Corticosteroids, and in some cases additional immunosuppressive agents, have shown success in managing similar cases [ 4 ][ 6 ]. This case highlights the need to consider aseptic abscesses in the differential diagnosis for SLE patients presenting with unexplained abscesses and negative cultures. Effective management requires a multidisciplinary team involving rheumatologists, radiologists, and infectious disease specialists to ensure accurate diagnosis and appropriate treatment. Conclusion Aseptic splenic abscess is a rare but important manifestation of SLE. Early diagnosis, appropriate drainage, and timely initiation of immunosuppressive therapy can lead to favorable outcomes. Abbreviations SLE systemic lupus erythematosus Declarations Ethics approval and consent to participate: Consent for publication: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient Availability of data and materials-none as it is a case report Competing interests: no competing interests. Funding: None. Authors contributions: being a sole author entire work done alone. Acknowledgements: None. References Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017;12(5):825-835. Chang KC et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases. World J Gastroenterol. 2006;12(3):460-464. Andre MF et al. Aseptic abscesses: a study of 30 patients. Medicine (Baltimore). 2007;86(3):145-161. Toma T et al. Aseptic abscess syndrome in SLE: a case report. Clin Rheumatol. 2007;26(9):1585-1588. Tektonidou MG et al. Arterial thrombotic events in SLE. Semin Arthritis Rheum. 2015;45(4):389-396. Shukla R et al. Aseptic splenic abscess in SLE. Indian J Rheumatol. 2016;11(1):37-39. Saigal S et al. Isolated aseptic splenic abscesses in SLE. Lupus. 2007;16(10):808-810. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7176528","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":499591977,"identity":"506c7ba1-ec05-4755-8b4b-a2d431ecb032","order_by":0,"name":"surya prakash thotanolla","email":"data:image/png;base64,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","orcid":"","institution":"Sri Venkateswara Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"surya","middleName":"prakash","lastName":"thotanolla","suffix":""}],"badges":[],"createdAt":"2025-07-21 10:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7176528/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7176528/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89259891,"identity":"1f3bb3c9-31e4-41a4-8045-0cbdbbf631f7","added_by":"auto","created_at":"2025-08-18 06:36:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":315550,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7176528/v1/493a1d128a172df2d2ee9d54.png"},{"id":89259628,"identity":"570b2d44-6f2e-4030-bb36-fd6ec76fb5e0","added_by":"auto","created_at":"2025-08-18 06:28:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":95642,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7176528/v1/5deef867f35b696a1afbd783.png"},{"id":89519691,"identity":"e1f191ca-9afa-40f7-9b25-678687192679","added_by":"auto","created_at":"2025-08-20 21:46:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":952305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7176528/v1/f369f73f-bf62-4dba-8ecc-839755fc0770.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rare Presentation of Lupus Nephritis with Aseptic Splenic Abscess: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eSystemic lupus erythematosus (SLE) is a multisystem autoimmune disorder characterized by autoantibody production and immune complex deposition. Lupus nephritis is a frequent and severe complication [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The development of splenic abscesses, particularly sterile or aseptic abscesses, is extremely rare in SLE and can present diagnostic challenges.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 25-year-old woman presented with left hypochondrial abdominal pain and intermittent fever for one month. She also reported bilateral lower limb swellings. On admission her blood pressure was 130/90 mm of hg in right arm, pulse rate was 86/min, all peripheral pulses are felt equally on both sides. On examination, tenderness was noted over the left hypochondrium. Her lab reports are presented below in table (1).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInvestigation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResult\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormal Range (where applicable)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.6 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12–16 g/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Leukocyte Count\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19,300 cells/cumm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,000–11,000 cells/cumm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlatelet Count\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.80 lakhs/cumm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5–4.5 lakhs/cumm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeripheral Smear\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormocytic Normochromic RBCs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum Creatinine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.47 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6–1.3 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood Urea\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15–40 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSodium\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130 mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135–145 mmol/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePotassium\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.6 mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5–5.0 mmol/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Protein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.4 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6–8 g/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum Albumin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0–5.5 g/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Bilirubin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.75 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 1.2 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDirect Bilirubin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 0.3 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAST (SGOT)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181 U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5–40 U/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eALT (SGPT)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5–45 U/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlkaline Phosphatase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181 U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45–150 U/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUrine Albumin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative to trace\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUrine Sugar\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNil\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRBCs (Urine)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1–2 /hpf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0–1 /hpf\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWBCs (Urine)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePlenty/hpf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0–5 /hpf\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEpithelial Cells (Urine)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2–4 /hpf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 5 /hpf\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHIV, HBsAg, HCV ELISA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum Cholesterol\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 200 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerum Triglycerides\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e346 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 150 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHDL Cholesterol\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt; 40 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLDL Cholesterol\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 100 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVLDL Cholesterol\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5–40 mg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCT Abdomen\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSplenic abscess (12×13×10 cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC3 and C4 Complement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANA Profile\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive: dsDNA, Nucleosome, Histone, SS-A/Ro 60 \u0026amp; 52 kD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANA IgG (ELISA)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 500 IU/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003edsDNA Antibody\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 800 IU/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 30 IU/mL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e24-hour Urine Protein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.3 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt; 150 mg/day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood and Urine Cultures\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo growth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSterile\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnti-Cardiolipin Antibody\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eCT abdomen revealed a 12x13x10 cm hypodense lesion (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)in the spleen suggestive of abscess. Empirical antibiotics were started, and ultrasound-guided drainage yielded 800 ml of fluid. Cultures and GeneXpert were negative. A diagnosis of aseptic splenic abscess associated with active SLE was made. The patient improved with drainage, antibiotics, and initiation of immunosuppressive therapy.\u003c/p\u003e\u003cp\u003eCT scan of both axial(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and coronal view (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)showing splenic abcess.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSplenic abscesses make up fewer than 1% of all intra-abdominal abscesses, making them a rare clinical condition. Most cases result from bacterial infections, with contributing variables such as immunosuppression, trauma, and hematogenous dissemination[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Aseptic abscesses, in contrast, are sterile, immune-mediated collections initially identified in relation to inflammatory bowel illness. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Their prevalence in systemic lupus erythematosus (SLE) is exceedingly uncommon. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe pathophysiology of aseptic abscesses in systemic lupus erythematosus is conjectural but may involve immune complex-mediated vasculitis, neutrophilic infiltration, and microvascular thrombosis. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These processes can result in localized tissue necrosis and sterile abscess formation. Such abscesses may be associated with the hypercoagulable state observed in systemic lupus erythematosus (SLE), particularly in patients with antiphospholipid antibodies; however, this patient tested negative for anticardiolipin antibodies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinically, aseptic abscesses closely mimic infectious ones, making differentiation challenging. Imaging studies such as CT or ultrasound typically reveal hypodense lesions, but these findings do not distinguish between septic and aseptic origins [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, microbiological testing is essential. In this case, repeated cultures and GeneXpert results were negative, and the lack of systemic signs of sepsis further suggested a non-infectious etiology.\u003c/p\u003e\u003cp\u003eManagement should be individualized. While initial treatment with empirical antibiotics and drainage is appropriate, early recognition of the abscess\u0026rsquo;s sterile nature should prompt timely initiation of immunosuppressive therapy to address the underlying autoimmune inflammation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Delayed immunosuppression can lead to further organ damage and unnecessary antibiotic exposure. Corticosteroids, and in some cases additional immunosuppressive agents, have shown success in managing similar cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis case highlights the need to consider aseptic abscesses in the differential diagnosis for SLE patients presenting with unexplained abscesses and negative cultures. Effective management requires a multidisciplinary team involving rheumatologists, radiologists, and infectious disease specialists to ensure accurate diagnosis and appropriate treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAseptic splenic abscess is a rare but important manifestation of SLE. Early diagnosis, appropriate drainage, and timely initiation of immunosuppressive therapy can lead to favorable outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSLE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esystemic lupus erythematosus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eConsent for publication: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials-none as it is a case report\u003cbr\u003e\u0026nbsp;Competing interests: \u0026nbsp;no competing interests.\u003cbr\u003e\u0026nbsp;Funding: None.\u003c/p\u003e\n\u003cp\u003eAuthors contributions: being a sole author entire work done alone.\u003cbr\u003e\u0026nbsp;Acknowledgements: None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlmaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017;12(5):825-835.\u003c/li\u003e\n\u003cli\u003eChang KC et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases. World J Gastroenterol. 2006;12(3):460-464.\u003c/li\u003e\n\u003cli\u003eAndre MF et al. Aseptic abscesses: a study of 30 patients. Medicine (Baltimore). 2007;86(3):145-161.\u003c/li\u003e\n\u003cli\u003eToma T et al. Aseptic abscess syndrome in SLE: a case report. Clin Rheumatol. 2007;26(9):1585-1588.\u003c/li\u003e\n\u003cli\u003eTektonidou MG et al. Arterial thrombotic events in SLE. Semin Arthritis Rheum. 2015;45(4):389-396.\u003c/li\u003e\n\u003cli\u003eShukla R et al. Aseptic splenic abscess in SLE. Indian J Rheumatol. 2016;11(1):37-39.\u003c/li\u003e\n\u003cli\u003eSaigal S et al. Isolated aseptic splenic abscesses in SLE. Lupus. 2007;16(10):808-810.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Systemic lupus erythematosus, aseptic abscess, splenic abscess, lupus nephritis, autoimmune disease","lastPublishedDoi":"10.21203/rs.3.rs-7176528/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7176528/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations. Although lupus nephritis is a common and severe manifestation, aseptic splenic abscess is extremely rare in SLE.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e\u003cp\u003eWe present the case of a 25-year-old female with lupus nephritis who developed an aseptic splenic abscess. The diagnosis was confirmed by imaging, negative cultures, serological markers, and active lupus nephritis features. The patient responded well to drainage and immunosuppressive therapy.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eAseptic splenic abscess is an uncommon but important differential diagnosis in SLE patients with unexplained abdominal pain and sterile collections. Early recognition and treatment are essential for optimal outcomes.\u003c/p\u003e","manuscriptTitle":"Rare Presentation of Lupus Nephritis with Aseptic Splenic Abscess: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 06:28:21","doi":"10.21203/rs.3.rs-7176528/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25079c25-90d6-4a6a-a49c-19927182f9a3","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-20T21:38:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-18 06:28:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7176528","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7176528","identity":"rs-7176528","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}