Plasmapheresis in neuropsychiatric involvement in systemic lupus erythematosus

Abstract

One of the most feared clinical presentations of systemic lupus erythematosus is neuropsychiatric involvement, specially associated psychosis. Diagnostic definitions are not well stablished to date however clinical suspicion and case registry has been increasing over time. There is scarce evidence regarding correct therapeutic approach to psychiatric presentations of systemic lupus erythematosus, however, it is well known that it is consequence of noxious autoimmune activity of the brain without structural compromise. Corticosteroids, cyclophosphamide and rituximab are part of the pharmacologic tools available. We present a case a 13 year old adolescent with new onset systemic lupus erythematosus in whom one of the principal initial concerns was how to address intense neuropsychiatric manifestations and specially refractory psychosis. First, high doses of steroid boluses were offered with no benefit in psychiatric symptoms, then cyclophosphamide was administered, with no success. Finally, therapeutic plasma exchange was offered to the patient with rapid clinical improvement. A total of 4 sessions of plasmapheresis with human albumin were done.