Lupus nephritis in an anti-nuclear antibody-negative young male - The simultaneous presence of class III and class V renal lesions

We report about a 27-year-old white male, a known case of class III lupus n ephritis with a very high anti-nuclear antibody (ANA) titer, who after 10 y ears of complete clinical and serological remission presented with sudden d evelopment of malar rash, proteinuria and an increase in the serum creatini ne. Repeated serologic studies were all negative for ANA. A repeat kidney b iopsy disclosed the presence of focal segmental glomerulosclerosis lupus ne phritis (class IIIc) superimposed with a new membranous lupus nephritis (cl ass V).