Successful Treatment of Lupus Cerebrovascular Disease with Mycophenolate Mofetil

Abstract

We report a case of neuropsychiatric systemic lupus erythematosus successfully treated with mycophenolate mofetil (MMF). The patient was a 40-year-old female who maintained with 7 mg of prednisolone plus 100 mg of azathioprine (AZ) per day. According to transient ischemic attack that occurred repeatedly and an elevated level of interleukin-6 (IL-6) in spinal fluid, she was diagnosed as having neuropsychiatric systemic lupus erythematosus (NPSLE). Initial increase in doses of prednisolone and AZ to 20 mg and 150 mg per day, respectively, was ineffective. After switching from AZ to MMF, her symptoms of NPSLE completely resolved with marked improvement of the IL-6 level in her spinal fluid, suggesting that MMF was effective.

Neuropsichiatric Manifestations of Systemic Lupus Erythematosus: Diagnosis and Treatment Approach

“…In maintenance treatment after induction therapy with cyclophosphamide or high-dose steroids, in severe NPSLE, azathioprine or mycophenolate mofetil can be used. (28,32,33) A recent revision reported the positive effects of rituximab (with high rates of response) and belimumab in severe NPSLE. (33).…”

Neuropsychiatric Systemic Lupus Erythematosus Involvement: Towards a Tailored Approach to Our Patients?

“… 66 There are case series reporting the use of azathioprine in maintenance treatment after cyclophosphamide or high-dose steroids in severe NPSLE, 64 and a few case reports of patients that were successfully treated with mycophenolate mofetil. 64 , 67 A recent revision summarized the positive effects of rituximab (with high rates of response) and belimumab in severe NPSLE. 68 In severe refractory cases, intravenous immunoglobulin 69 , 70 and plasmapheresis 71 , 72 have been successfully used as bridge therapy, mainly when infection is not completely ruled out, in pregnant patients, or when there are life-threatening symptoms.…”