title: Mycophenolate mofetil and intravenous dexamethasone in the treatment of persistent lupus myelitis.
abstract: Methylprednisolone and cyclophosphamide pulse therapies are the most commonly used for transverse myelopathy in neuropsychiatric lupus. Little is known about the efficacy of other immunosuppressors. We describe the case of a 33-year-old woman with systemic lupus erythematosus, who developed a tranverse myelopathy, beginning with a hiccup due to involvement of the medulla oblongata; despite pulses of methylprednisolone plus azathioprine and cyclosporine therapy, she developed paraparesis with involvement of the cervical spine cord. After oral cyclophosphamide, the lesion remained active. Subsequent therapy with mycophenolate mofetil and continuous intravenous infusions of dexamethasone resulted in reduction of the lesion's size, disappearance of magnetic resonance imaging enhancement, and a complete recovery.
authors.affiliation: Division of Rheumatology, University of Udine, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tomietto
authors.forename: Serena
authors.initials: S
authors.lastname: D'Agostini
authors.forename: Virginia
authors.initials: V
authors.lastname: Annese
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009187:Myelitis / Q000188:drug therapy* / Q000209:etiology; D020335:Paraparesis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D009173:Mycophenolic Acid