Integrative Use of Belimumab and Individualized Traditional Chinese Medicine in Refractory Pediatric Lupus Nephritis: A Case Report.

Background: Pediatric lupus nephritis (LN) is characterized by rapid progression and presents considerable therapeutic challenges. Standard immunosuppressive regimens may be insufficient in refractory cases, which are often marked by frequent relapses and poor long-term outcomes. Belimumab, a monoclonal antibody targeting B lymphocyte stimulator (BLyS), and individualized traditional Chinese medicine (TCM) interventions have demonstrated respective benefits in LN management. This case report describes the clinical course of a child with refractory LN that was managed using an integrative approach combining belimumab with individualized TCM therapy. Case Presentation: A pediatric patient with LN presented with persistent gross hematuria, conventional glucocorticoids immunosuppressants and hydroxychloroquine treatment failed to achieve adequate disease control. Subsequent administration of belimumab in combination with an individualized TCM formulation led to notable clinical improvement, including significant reductions in proteinuria and hematuria, along with a marked decline in systemic lupus erythematosus disease activity. Background medications were gradually tapered during the treatment course. No serious adverse effects were observed, and clinical remission was sustained throughout the follow-up period. Conclusion: The combination of belimumab and individualized TCM may safely and effectively control refractory childhood LN, reduce corticosteroid dosage, and sustain remission; however, validation through studies with larger sample sizes is required.