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Laboratory tests such as antinuclear antibody and antidouble-stranded DNA (anti-dsDNA), using the <jats:italic>Crithidia luciliae<\/jats:italic> assay, exhibit high sensitivity (98%) and specificity (99%) in detecting SLE, respectively. Approximately half of patients with SLE develop lupus nephritis, which is associated with significant morbidity and a mortality rate of 5%\u201325%\u2009due to progression to kidney failure. The histological classification of lupus nephritis, particularly classes IV and V, is pivotal in its diagnosis and management. This case report describes a young woman in her 20s with lupus nephritis characterised by delayed seropositivity and no other clinical manifestations. It also underscores the importance of follow-up care to manage medication side effects and prevent disease sequelae, such as thromboses.<\/jats:p>","DOI":"10.1136\/bcr-2024-261398","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T03:10:14Z","timestamp":1746673814000},"page":"e261398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed seropositive lupus nephritis: a clinical dilemma"],"prefix":"10.1136","volume":"18","author":[{"given":"Aniruddha","family":"Bhattacharyya","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5837-8458","authenticated-orcid":false,"given":"Ramy Safwat Tawfik","family":"Gadalla","sequence":"additional","affiliation":[{"name":"Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ishaan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan M","family":"Lockwood","sequence":"additional","affiliation":[{"name":"Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DongHyang (Ann)","family":"Kwon","sequence":"additional","affiliation":[{"name":"Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Negiin","family":"Pourafshar","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"2025082711354697000_18.5.e261398.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223035"},{"key":"2025082711354697000_18.5.e261398.2","doi-asserted-by":"crossref","DOI":"10.1136\/lupus-2020-000389","article-title":"Prediction of prognosis and renal outcome in lupus nephritis","volume":"7","author":"Parodis","year":"2020","journal-title":"Lupus Sci Med"},{"key":"2025082711354697000_18.5.e261398.3","doi-asserted-by":"crossref","unstructured":"Bomback AS , D\u2019Agati VD , et al . 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