J Rheum Dis.  2014 Jun;21(3):143-146. 10.4078/jrd.2014.21.3.143.

A Case of Acute Inflammatory Demyelinating Polyradiculoneuropathy in a Patient with Systemic Lupus Erythematosus

• Lee JW
• Kang JH
• Hong HJ
• Ju SM
• Lee KE
• Wen L
• Park DJ
• Kim TJ
• Park YW
• Lee SS

• KMID: 2297526
• DOI: http://doi.org/10.4078/jrd.2014.21.3.143

Abstract

Neuropsychiatric manifestations in patients with systemic lupus erythematosus are fairly common, with a prevalence of 37~95%. Among 19 neuropsychiatric manifestations, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is quite rare, and is characterized by progressive, symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes. Generally, plasma exchange and intravenous immunoglobulin are the main treatment modalities. Here, we report a case of AIDP in a 29-year-old SLE patient, who was fully recovered with a treatment of high-dose glucocorticoid and immunosuppressive agents. Ours case suggests that AIDP should be treated differently in SLE patients to avoid disastrous results.

Keyword

Systemic lupus erythematosus; Central nervous system; Polyradiculoneuropathy

MeSH Terms

Adult
Central Nervous System
Guillain-Barre Syndrome*
Humans
Immunoglobulins
Immunosuppressive Agents
Lupus Erythematosus, Systemic*
Muscle Weakness
Plasma Exchange
Polyradiculoneuropathy
Prevalence
Reflex, Stretch
Immunoglobulins
Immunosuppressive Agents

Reference

1. Wang M, Gladman DD, Ibañez D, Urowitz MB. Longterm outcome of early neuropsychiatric events due to active disease in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012; 64:833–7.

2. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999; 42:599–608.

3. Bertsias GK, Boumpas DT. Pathogenesis, diagnosis and management of neuropsychiatric SLE manifestations. Nat Rev Rheumatol. 2010; 6:358–67.

4. Bertsias GK, Ioannidis JP, Aringer M, Bollen E, Bombardieri S, Bruce IN, et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis. 2010; 69:2074–82.

5. Firestein GS, Budd RC, Gabriel SE, Mclnnes IB, O'Dell JR. Kelley's textbook of rheumatology. 9th ed.p. 1297. Philadelphia: Elsevier/Saunders;2013.

6. Nishimoto Y, Odaka M, Hirata K, Yuki N. Usefulness of anti-GQ1b IgG antibody testing in Fisher syndrome compared with cerebrospinal fluid examination. J Neuroimmunol. 2004; 148:200–5.

7. Gordon PH, Wilbourn AJ. Early electrodiagnostic findings in Guillain-Barré syndrome. Arch Neurol. 2001; 58:913–7.

8. Labrador-Horrillo M, Martinez-Valle F, Gallardo E, Rojas-Garcia R, Ordi-Ros J, Vilardell M. Anti-ganglioside antibodies in patients with systemic lupus erythematosus and neurological manifestations. Lupus. 2012; 21:611–5.

9. Lo YL. Clinical and immunological spectrum of the Miller Fisher syndrome. Muscle Nerve. 2007; 36:615–27.

10. Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012; 366:2294–304.

11. Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003; 61:736–40.

12. Bartolucci P, Bréchignac S, Cohen P, Le Guern V, Guillevin L. Adjunctive plasma exchanges to treat neuropsychiatric lupus: a retrospective study on 10 patients. Lupus. 2007; 16:817–22.

13. Milstone AM, Meyers K, Elia J. Treatment of acute neuropsychiatric lupus with intravenous immunoglobulin (IVIG): a case report and review of the literature. Clin Rheumatol. 2005; 24:394–7.

14. Tokunaga M, Saito K, Kawabata D, Imura Y, Fujii T, Nakayamada S, et al. Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system. Ann Rheum Dis. 2007; 66:470–5.

15. Matsuki Y, Hidaka T, Matsumoto M, Fukushima K, Suzuki K. Systemic lupus erythematosus demonstrating serum anti-GM1 antibody, with sudden onset of drop foot as the initial presentation. Intern Med. 1999; 38:729–32.