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.