Lupus nephritis association with idiopathic CD4 + T lymphocytopenia: a case report of a young man with recalcitrant warts

Tingting Wang; Shaojun Liu; Xiaowan Liang; Jun Xue; Li You; Xiaoye Zhu

doi:10.1186/s12882-025-04259-0

Lupus nephritis association with idiopathic CD4 + T lymphocytopenia: a case report of a young man with recalcitrant warts

BMC Nephrol. 2025 Jul 12;26(1):381. doi: 10.1186/s12882-025-04259-0.

Authors

Tingting Wang¹, Shaojun Liu¹, Xiaowan Liang¹, Jun Xue¹, Li You¹, Xiaoye Zhu²

Affiliations

¹ Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
² Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, 200040, China. xiaoyezhu@fudan.edu.cn.

Abstract

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease in which the immune system is in a disordered state, with excessive production of autoantibodies and abnormal functions of immune cells. This imbalance in the immune system alters the body's defense capabilities against various pathogens. Patients with idiopathic CD4⁺ T lymphocytopenia (ICL) have a reduced number of lymphocytes, and the function of the immune system is also impaired. Human papillomavirus (HPV) infects human body and mainly lurks and replicates in skin and mucosal cells.

Case report: A 35-year-old Chinese male was admitted to the Nephrology department, with a three-year history of recalcitrant warts and a six-month history of generalized edema and fatigue. Physical examination identified verruca vulgaris on the limbs and face. Laboratory examinations demonstrated CD4⁺ T lymphocytopenia, low levels of C3 complement, and positive antinuclear antibodies. Renal function tests indicated nephrotic syndrome. Renal biopsy findings were consistent with Class V lupus nephritis (LN). Based on the 2019 EULAR/ACR criteria, the patient was diagnosed with systemic lupus erythematosus (SLE) and treated with prednisone and tacrolimus. However, after six months, no remission was observed. With the administration of Belimumab, a significant improvement in his renal symptoms and stabilization of cutaneous lesions were noted at the 12-month follow-up.

Conclusion: This particular case emphasizes the significance of taking into account the potential presence of underlying immunodeficiency in patients with recalcitrant warts and formulating appropriate treatment strategies. Such patients necessitate meticulous and continuous follow-up by both the dermatology and immunology specialties to vigilantly monitor the emergence of other diseases associated with ICL. Belimumab has manifested outstanding efficacy and safety profiles in SLE patients with compromised immune function.

Keywords: Human papillomavirus (HPV); Idiopathic CD4 + T lymphocytopenia; Lupus nephritis; Systemic lupus erythematosus; Warts.

Publication types

Case Reports

MeSH terms

Adult
Humans
Lupus Nephritis* / complications
Lupus Nephritis* / diagnosis
Lupus Nephritis* / drug therapy
Male
T-Lymphocytopenia, Idiopathic CD4-Positive* / complications
T-Lymphocytopenia, Idiopathic CD4-Positive* / diagnosis
T-Lymphocytopenia, Idiopathic CD4-Positive* / drug therapy
Warts* / complications
Warts* / drug therapy