Prolonged Remission of SLE-associated Polyradiculoneuropathy after a Single Course of Intravenous Immunoglobulin

Abstract

Polyradiculoneuropathy is a rare and potentially severe complication of systemic lupus erythematosus (SLE). Treatment is not codified and response to corticosteroid is inconstant. We report the case of a patient with severe SLE-associated polyradiculoneuropathy and autoimmune thrombocytopenia. Dramatic neurologic improvement and correction of thrombocytopenia were observed after a single course of high-dose intravenous immunoglobulin infusions (IVIg, 2g/kg body weight). Our case suggests that IVIg may be effective in the treatment of this unusual condition.

Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee

“…No double-blind, placebo-controlled trials of IVIG have been published for the neuropathy associated with Sjogren's syndrome, [41][42][43][44][45][46][47] Churg-Strauss angiitis, 48,49 systemic sclerosis, 50 anti-sulfatide neuropathy, 51,52 postinfection sensory neuropathy, 53 sarcoidosis, 54 systemic lupus erythematosus, 55 CAN-OMAD (chronic ataxic neuropathy, ophthalmoplegia, monoclonal protein, agglutination, and disialosyl antibodies), 56 and inflammatory bowel disease. 57 The best available Class IV evidence suggests that some of these patients improve after receiving IVIG.…”

Current and novel therapeutics in the treatment of systemic lupus erythematosus

“…There are no large randomized clinical trials looking at the efficacy of IVIG in SLE. There are small clinical trials, case series, and case reports in the literature supporting its use in SLE patients with arthritis, fever, thrombocytopenia[58, 59], neuropsychiatric SLE[59, 60], myocarditis[61], cardiac tamponade[62], end-stage renal disease[63], chorea[64], polyradiculopathy[65], myelofibrosis[66], pneumonitis[67], membranous or membranoproliferative lupus nephritis[68]. There is a pilot study showing temporary beneficial effects in mildly to moderately active SLE.…”

Intravenous immunoglobulin (IVIg) for therapy‐resistant cutaneous lupus erythematosus (LE)

“…2 The place of intravenous immunoglobulin (IVIg) in the therapy of Kawasaki disease 3 and idiopathic thrombocytopenic purpura 4 is clear, yet its place in dermatomyositis is less so. [5][6][7] High dose IVIg has been used successfully in LE to treat haematological 8 and neurological disease 9,10 The potential for intravenous immunoglobulin in patients with cutaneous LE has been explored with both success 11 and failure 12 and has been recently reviewed. 13 …”