Successful Cyclosporine Salvage Therapy in Refractory Lupus Nephritis: A Case Study From Ethiopia

Abstract

Background: Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE), often requiring immunosuppressive therapy. Standard regimens include corticosteroids, mycophenolate mofetil (MMF), or cyclophosphamide. Calcineurin inhibitors (CNIs) have shown therapeutic promise, but their use in low-income settings remains constrained by limited availability and cost. Objective: To highlight the potential role of cyclosporine as salvage therapy in class V lupus nephritis when conventional treatments fail or are inaccessible, particularly in resource-limited settings. Methods: We report the clinical course of a 28-year-old Ethiopian woman with biopsy-proven class V lupus nephritis and nephrotic syndrome. The patient presented with fatigue and generalized edema. Initial therapy with MMF and corticosteroids was administered, but no clinical improvement was observed. Cyclosporine-based triple therapy was subsequently introduced, alongside supportive care. Results: Following initiation of cyclosporine, the patient achieved partial remission characterized by reduction in proteinuria and stabilization of clinical symptoms. Generalized edema improved, and fatigue lessened. No major adverse effects were reported during the observation period. Conclusions: Cyclosporine may serve as a pragmatic therapeutic option for class V lupus nephritis in resource-limited settings where standard regimens are ineffective or unavailable. This case underscores the importance of considering CNIs as salvage therapy. Further controlled studies are warranted to evaluate efficacy, safety, and to define the role of cyclosporine in treatment algorithms for lupus nephritis.