Simultaneous affection of central and peripheral nervous system in systemic lupus erythematosus patients

Overview

Objective.
According to recent epidemiological studies neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are the most frequent (up to 80 %) and the most variable (19 syndroms) organ manifestations of SLE. Diagnosis and differential diagnosis of SLE are difficult and require an interdisciplinar cooperation. Case report. A 49-year-old SLE patient treated with cyclosporin A developed dysesthesias and paresthesias in the lower extremities persisting and progressing even after discontinuation of the treatment. Detailed neurological examination, including electrophysi-ological methods, found sensomotoric polyneuropathy and neocerebellar syndrom. Magnetic resonance imaging of the brain described multiple focuses in the white matter of the brain corresponding to vasculopathy. No alteration of blood-brain barrier was revealed. Oligocytosis of monocytes and intrathecal synthesis of immunoglobulins were found in the liquor. Patients were treated with methylprednisolone (32mg per day) and with monthly pulses of intravenous cyclophosphamide. Improvement of subjective status and electromyographic findings were found after 6th pulse of cyclophosphamide. Conclusion. Nervous system in SLE can be affected in multiple ways. In this case, combination of i.v cyclophosphamide and glucocorticoid treatment favourably affected central and peripheral nervous system and was well tolerated.

Key words:
neuropsychiatric systemic lupus erythematosus (NPSLE), sensoric and motoric demye-linization polyneuropathy, treatment of NPSLE