The patient was a 33 year female. In 2001, she was diagnosed with
systemic lupus erythematosus (SLE) and treated with
prednisolone and
ciclosporin. In May 2006, she noticed slight
muscle weakness in the bilateral lower limbs. In July of the same year, she experienced gait difficulty and was admitted to our hospital because of
fatigue, appetite loss,
fever and disorientation. Soon afterwards, she had a fit of general convulsion and suffered from
urinary retention and
fecal incontinence. A brain magnetic resonance image revealed
atrophy of the thoracic cord in T2 weighted images, and cerebrospinal fluid examination showed high total
protein and
interleukin-6 concentration, indicating complication of lupus
myelitis as well as cerebral involvement.
Steroid pulse and oral
prednisolone treatment resulted in ameriolation of cerebral complications such as disorientation and convulsion, but
muscle weakness and
paresthesia in the lower limbs and
urinary retention persisted.
Cyclophosphamide pulse
therapy was started and resulted in a marked recovery from
muscle weakness,
paresthesia and
urinary retention, and she could discharge. We conclude that
steroid and
cyclophosphamide pulse
therapy for a SLE patient with CNS lupus and lupus myelitisis is effective for ameriolation of symptoms such as disorientation, convulsion, urinary retension,
fecal incontinence,
muscle weakness and
paresthesia in the lower limbs as well as elevated level of serum anti-ribosomal P antibody.