title: Susac syndrome treated with subcutaneous immunoglobulin.
abstract: BACKGROUND
  Susac syndrome is a rare disease characterized by the triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss mainly affecting young women. The finding of antibodies against the endothelium in the sera of these patients has supported the hypothesis of an autoimmune endotheliopathy of the brain, inner ear and retina. Because of the rarity of the disease, treatment is based on the knowledge of case reports and small case series. Medical therapy consists of glucocorticoids, immunosuppressants, acetyl salicylic acid, and immunomodulatory agents such as intravenous immunoglobulin.
  
  
  METHODS
  We present the case histories of 2 young women with Susac syndrome presenting with several episodes of encephalopathy, branch retinal artery occlusions, and hearing loss that were treated with different immunosuppressive drugs, glucocorticoids and intravenous immunoglobulin. In the course of the disease, the treatment was successfully switched to subcutaneous immunoglobulin without any further relapse in both patients.
  
  
  CONCLUSIONS
  We conclude that the application of subcutaneous immunoglobulin is easy to learn, helps to reduce in-hospital costs and enables a more flexible everyday life. The treatment with subcutaneous immunoglobulin helps to reduce immunosuppressants and appears to prevent relapses.
authors: Department of Neurology, University of Münster, Münster, Germany.
authors: Ilka
authors: I
authors: Kleffner
authors: Jan
authors: J
authors: Dörr
authors: Thomas
authors: T
authors: Duning
authors: Peter
authors: P
authors: Young
authors: E Bernd
authors: EB
authors: Ringelstein
authors: Matthias
authors: M
authors: Schilling
mesh_terms: D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D015918:Infusion Pumps, Implantable; D055104:Infusions, Subcutaneous; D012646:Self Administration; D055955:Susac Syndrome / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007136:Immunoglobulins; D007155:Immunologic Factors