Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral centre

被引:24
作者
Rodrigues, M. [1 ]
Galego, O. [2 ]
Costa, C. [1 ]
Jesus, D. [1 ]
Carvalho, P. [1 ]
Santiago, M. [1 ]
Malcata, A. [1 ]
Ines, L. [1 ]
机构
[1] Ctr Hosp & Univ Coimbra, Dept Rheumatol, Coimbra, Portugal
[2] Ctr Hosp & Univ Coimbra, Dept Neuroradiol, Coimbra, Portugal
关键词
Neuropsychiatric lupus; vasculitis; magnetic resonance imaging; cyclophosphamide; intravenous human immunoglobulin; CEREBRAL VASCULITIS; MANIFESTATIONS; CYCLOPHOSPHAMIDE; ANGIOGRAPHY; DIAGNOSIS; DISEASE;
D O I
10.1177/0961203317694259
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Central nervous system (CNS) vasculitis (CNS) in systemic erythematosus lupus (SLE) is a rare and challenging diagnosis. We report four cases of CNS vasculitis that occurred 5 to 16 years after the diagnosis of SLE. Magnetic resonance imaging (MRI) detected different features suggestive of CNS vasculitis: enhancement and thickening of the vascular wall, vascular stenosis, ischemic brain lesions and intracerebral haemorrhage unlikely to correspond to other mimic aetiologies. Three patients received combination therapy with glucocorticoids (GC) and cyclophosphamide (CYC). Intravenous human immunoglobulin (IVIG) was administered when the patient had a past history of serious adverse event to CYC or high infectious risk. All patients showed imagiological improvement, at least partially, 5 to 23 days after starting treatment. We discuss the management of CNS in SLE including the role of magnetic resonance imaging (MRI).
引用
收藏
页码:1440 / 1447
页数:8
相关论文
共 17 条
[1]   Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus [J].
Barile-Fabris, L ;
Ariza-Andraca, R ;
Olguín-Ortega, L ;
Jara, LJ ;
Fraga-Mouret, A ;
Miranda-Limón, JM ;
de la Mata, JF ;
Clark, P ;
Vargas, F ;
Alcocer-Varela, J .
ANNALS OF THE RHEUMATIC DISEASES, 2005, 64 (04) :620-625
[2]   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 [J].
Bertsias, G. K. ;
Ioannidis, J. P. A. ;
Aringer, M. ;
Bollen, E. ;
Bombardieri, S. ;
Bruce, I. N. ;
Cervera, R. ;
Dalakas, M. ;
Doria, A. ;
Hanly, J. G. ;
Huizinga, T. W. J. ;
Isenberg, D. ;
Kallenberg, C. ;
Piette, J. C. ;
Schneider, M. ;
Scolding, N. ;
Smolen, J. ;
Stara, A. ;
Tassiulas, I. ;
Tektonidou, M. ;
Tincani, A. ;
van Buchem, M. A. ;
van Vollenhoven, R. ;
Ward, M. ;
Gordon, C. ;
Boumpas, D. T. .
ANNALS OF THE RHEUMATIC DISEASES, 2010, 69 (12) :2074-2082
[3]   Pathogenesis, diagnosis and management of neuropsychiatric SLE manifestations [J].
Bertsias, George K. ;
Boumpas, Dimitrios T. .
NATURE REVIEWS RHEUMATOLOGY, 2010, 6 (06) :358-367
[4]   Magnetic resonance angiography in suspected cerebral vasculitis [J].
Demaerel, P ;
De Ruyter, N ;
Maes, F ;
Velghe, B ;
Wilms, G .
EUROPEAN RADIOLOGY, 2004, 14 (06) :1005-1012
[5]   Cyclophosphamide in combination with glucocorticoids for severe neuropsychiatric systemic lupus erythematosus: a retrospective, observational two-centre study [J].
Fanouriakis, A. ;
Pamfil, C. ;
Sidiropoulos, P. ;
Damian, L. ;
Flestea, A. ;
Gusetu, G. ;
Rednic, S. ;
Bertsias, G. ;
Boumpas, D. T. .
LUPUS, 2016, 25 (06) :627-636
[6]   The Role of Imaging in the Diagnosis of Central Nervous System Vasculitis [J].
Gomes, Lavier J. .
CURRENT ALLERGY AND ASTHMA REPORTS, 2010, 10 (03) :163-170
[7]   Granulomatous cerebral vasculitis in systemic lupus erythematosus during systemic remission of disease [J].
Koerner, C ;
Sommer, C ;
Knauth, M ;
Breitbart, A ;
Wildemann, B .
JOURNAL OF NEUROLOGY, 2000, 247 (09) :722-724
[8]   Cerebral vasculitis:: imaging signs revisited [J].
Kueker, Wilhelm .
NEURORADIOLOGY, 2007, 49 (06) :471-479
[9]  
Liang MH, 1999, ARTHRITIS RHEUM-US, V42, P599
[10]   GADOLINIUM-ENHANCED MAGNETIC-RESONANCE-IMAGING OF THE CENTRAL-NERVOUS-SYSTEM IN SYSTEMIC LUPUS-ERYTHEMATOSUS [J].
MILLER, DH ;
BUCHANAN, N ;
BARKER, G ;
MORRISSEY, SP ;
KENDALL, BE ;
RUDGE, P ;
KHAMASHTA, M ;
HUGHES, GRV ;
MCDONALD, WI .
JOURNAL OF NEUROLOGY, 1992, 239 (08) :460-464