title: Short-term add-on tocilizumab and intravenous cyclophosphamide exhibited a remission-inducing effect in a patient with systemic lupus erythematosus with refractory multiorgan involvements including massive pericarditis and glomerulonephritis.
abstract: We report on a 41-year-old woman with refractory systemic lupus erythematosus with massive pericarditis, macrophage activation syndrome, and glomerulonephritis despite high-dose glucocorticoids and tacrolimus. Tocilizumab dramatically improved pericarditis, and glomerulonephritis was controlled after adding cyclophosphamide. We had to halt tocilizumab and cyclophosphamide due to possible pneumocystis infection after five and three infusions of tocilizumab and intravenous cyclophosphamide, respectively. Nevertheless, no lupus flare had been observed on glucocorticoid monotherapy and enabled further rapid tapering prednisolone.
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital , Nagoya, Aichi , Japan.|c Department of Geriatric and Environmental Dermatology , Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Iwai
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital , Nagoya, Aichi , Japan.|b Department of Respiratory Medicine , Allergy and Clinical Immunology , Nagoya, Aichi , Japan.
authors.forename: Taio
authors.initials: T
authors.lastname: Naniwa
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital , Nagoya, Aichi , Japan.|b Department of Respiratory Medicine , Allergy and Clinical Immunology , Nagoya, Aichi , Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Tamechika
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital , Nagoya, Aichi , Japan.|b Department of Respiratory Medicine , Allergy and Clinical Immunology , Nagoya, Aichi , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Maeda
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D010493:Pericarditis / Q000150:complications / Q000188:drug therapy*; D012074:Remission Induction
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; C502936:tocilizumab
keywords: Cyclophosphamide; Pericarditis; Systemic lupus erythematosus; Tocilizumab