Efficacy of Belimumab for Active Lupus Nephritis in a Young Asian Man with Latent Pulmonary Tuberculosis: A Case Report.

INTRODUCTION: Managing active lupus nephritis (LN) in the presence of latent tuberculosis (TB) presents a significant treatment challenge. Traditional treatment with glucocorticoids combined with mycophenolic acid carries a high risk of triggering pulmonary TB infection in LN patients. In this report, we discuss a novel approach using belimumab in combination with rapidly tapering corticosteroids to treat a patient with active class IV and V LN and latent TB.

CASE PRESENTATION: A 24-year-old Chinese male was diagnosed with active class IV and V LN and latent TB. He underwent induction therapy with a combination of belimumab, rapidly tapering methylprednisolone and mycophenolate mofetil. After 18 months of belimumab therapy, the patient's blood albumin levels and kidney function normalized, with 24-h urinary protein levels stabilizing between 500 mg and 725 mg. Notably, there was no recurrence of TB.

CONCLUSION: This case demonstrates that the combination of belimumab and rapid corticosteroid tapering effectively reduced the duration of high-dose glucocorticoid therapy, highlighting the efficacy and safety of belimumab in managing LN with latent TB.