Intravenous Immunolobulin (IV Ig) Treatment of Demyelinating Polyneuropathy in Patient with Systemic Lupus Erythematosus (SLE) : A Case Report and Review of the Literatures.

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Siraphop Suwannaroj
Ratanavadee Nanagara
Valee Harisdandkul

Abstract

Background : Demyelinating polyneuropathy is an uncommon manifestation in SLE. Clinical manifestations include motor weakness, sensory loss and hyporeflexia resemble Guillian-Barre’ syndrome (GBS). Treatment is still not well document. Response to corticosteroids is inconsistent.

Objective :  Herein is a case report of IV lg treatment of polyneuropathy in patient with SLE.

Result :  A 40 year-old African American woman with polyrthralgia was diagnosed having rheumatoid arthritis (RA). She had positive rheumatoid factor, positive ANA, Positive anti-ds-DNA, Positive anti-SSA and anti-SSB antibodies. She was treated with non-steroidal anti-inflammatory drug (NSAID) and methotrexate. Three months later, she presented with generalized weakness, swollen lips and fact, polyarthragia and intermittent left sided numbness for 2 week prior to being seen. Physical examination revealed quadriparesis predorminately at the proximal groups and hyporflexia. Laboratory findings showed elevated anti-ds-DNA,decreased serum compiment levels and postitive anticardiolipin antibodies. CSF study showed normal profile with 3 WBC/mm3 , glucose of 77 mg / dl and protien of 76 mg / dl. Electromygraphic (EMG) and nerve conduction test (NCT) showed diffuse demyelinating polyneuropathy. Renal function was normal but urinalysis showed 2.26 gm of protien in 24 hours. The diagnosis of SLE was made and she was treated with intravenous methyprednisolone (IV MP) 1 gm daily for 6 days and azathioprine (AZA) 100 md/day. However the patient showed no Improvement, thus IV lg 50 gm daily for 2 day was given. Rapid improvenment was seen within one week. One month later, 2 days course of 50 gm of IV lg was repeated with further improvenment. There was no complication of IV lg therapy in this patient. The meachanisms of action, adverse effect and clinical uses of IV lg in various manifestations of SLE patients were also reviewed.

Conclusion : A case of Demyelinating polyneuropathy in SLE patient was reported. IV lg treatment appeared to be beneficial in certain manifestations of SLE including demyelinating polyneuropathy as described in this report. It should be used as an adjunct treatment with caution. Renal toxicity has been described especially in elderly patients and patient who has pre-existing renal disorder.

Key Words :  IV lg, SLE, Polyradiculopathy

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1.
Suwannaroj S, Nanagara R, Harisdandkul V. Intravenous Immunolobulin (IV Ig) Treatment of Demyelinating Polyneuropathy in Patient with Systemic Lupus Erythematosus (SLE) : A Case Report and Review of the Literatures. Srinagarind Med J [Internet]. 1 [cited 2021Oct.23];13(2):107-11. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/14088
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Case report