{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T20:28:46Z","timestamp":1758054526345,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,8,28]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Overlap syndrome with systemic lupus erythematosus (SLE) and granulomatous polyangiitis with antineutrophil cytoplasmic antibody (ANCA) is rare. There are no international guidelines or randomised controlled trials for management.<\/jats:p>\n               <jats:p>We present a woman in her 50s of Indian origin with a longstanding history of SLE who presented with new onset haematuria, rapidly declining kidney function and new proteinase-3-ANCA diagnosis. Biopsy findings were consistent with both lupus nephritis (LN) and ANCA-associated vasculitis (AAV)\u2014predominantly ANCA vasculitis given the necrotising and crescentic features on histopathology. She was pulsed with methylprednisolone and subsequently managed with six cycles of low-dose intravenous cyclophosphamide with improvement to her kidney function. Her admission was complicated by cytomegalovirus (CMV) associated perinasal ulcers and colitis, which was managed with antiviral therapy.<\/jats:p>\n               <jats:p>AAV\/LN overlap syndrome is uncommon. Interaction between ANCA and SLE is not well understood.<\/jats:p>\n               <jats:p>Readers should read more about CMV and its associated complications. Routine testing for CMV in the form of serology should be considered for patients prior to starting immunosuppressive therapy.<\/jats:p>","DOI":"10.1136\/bcr-2024-263962","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:45:19Z","timestamp":1757911519000},"page":"e263962","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["ANCA and SLE overlap syndrome: treatment with intravenous cyclophosphamide complicated by CMV infection"],"prefix":"10.1136","volume":"18","author":[{"given":"Ervine AR","family":"Cheong","sequence":"first","affiliation":[{"name":"Department of Nephrology, Grampians Health Ballarat, Ballarat, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susheel","family":"Sharma","sequence":"additional","affiliation":[{"name":"Grampians Health Ballarat, Ballarat, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Dow","sequence":"additional","affiliation":[{"name":"Western Health, Victoria, Victoria, Australia"},{"name":"Dorevitch Pathology, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Nirenberg","sequence":"additional","affiliation":[{"name":"Dorevitch Pathology, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"2025091421451358000_18.9.e263962.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40930"},{"key":"2025091421451358000_18.9.e263962.2","first-page":"221","article-title":"Predicting patients who are likely to develop Lupus Nephritis of those newly diagnosed with Systemic Lupus Erythematosus","volume":"2022","author":"Bechler","year":"2022","journal-title":"AMIA Annu Symp 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