Correspondence authors
Xinling Liang, Department of Nephrology, Guangdong Provincial People’s
Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080,
People’s Republic of China
Phone: +8613808819770; Fax: (86)20-83827812-62027;
E-mail:xinlingliang_ggh@163.com
Shuangxin Liu, Department of Nephrology, Guangdong Provincial People’s
Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080,
People’s Republic of China
Phone: +8613543456446; Fax: (86)20-83827812-62027;
E-mail:13543456446@163.com
Abstract
Neuropsychiatric systemic lupus erythematosus (NPSLE) is usually
associated with a worse prognosis. However, there are few effective
treatments for NPSLE. We described protein A immunoadsorption treatment
for a patient with NPSLE. The patient’s brain lesions was improved
rapidly after two sessions of protein A immunoadsorption combination
with immunosuppressive agent treatment.
Key Words: Protein A immunoadsorption, Neuropsychiatric
systemic lupus erythematosus,
Key Clinical Message
We described firstly protein A immunoadsorption combination with
immunosuppressive treatment improved rapidly a patient with NPSLE.
1 INTRODUCTION
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with
a broad spectrum of clinical presentations [1]. The neuropsychiatric
SLE (NPSLE) presents with heterogeneous symptoms, such as headache,
cognitive impairment, memory loss, seizure and stroke which contributes
considerably to morbidity and mortality. The development and
deterioration of NPSLE are associated with the formation of a large
number of auto-antibodies and circulating immune complexes in the body,
which could cause severe brain damage and even
life-threatening
[2]. Inhibiting or removing pathogenic auto-antibodies could prevent
their pathological outcomes [1]. Severe NPSLE should be treated with
immunosuppressive and biological agents. However, some patients are not
sensitive to these drugs. Protein A immunoadsorption (IAS) has been
shown to improve disease activity and lower glucocorticoid dosages in
lupus nephritis [3]. Braun and colleague reported that protein A
immunoadsorption had effect on severe and therapy-resistant SLE, which
suggested IAS as a possible option when other therapies were ineffective
[4]. We presented a case of NPSLE, who received 3 sessions of IAS
treatment after poor responses to immunosuppressive agents. The
significant improvement of brain magnetic resonance imaging (MRI)
manifestations have been firstly reported after the comprehensive
treatments.