Case Report

B Cell Loss Leading to Remission in Severe Systemic Lupus Erythematosus

TERESA K. TARRANT, D. HUGH FRAZER, JAMES P. AYA-AY, and DHAVALKUMAR D. PATEL

ABSTRACT.

Systemic lupus erythematosus (SLE) pathogenesis is mediated in part by autoantibodies. We describe a patient with central nervous system lupus who developed a loss of B cells with associated hypogammaglobulinemia and sinopulmonary infections requiring intravenous immunoglobulin. The SLE went into complete remission. Of 18 reported patients with SLE developing persistent hypogammaglobulinemia, only 5 patients including ours had a nearly complete loss of circulating B cells. Of those whose SLE and B cell status was reported, 5/5 with B cell loss and 1/10 without B cell loss experienced a durable response of SLE (p = 0.002). These cases illustrate that B cell ablative therapies may have efficacy for SLE. (J Rheumatol 2003;30:412-4)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
HYPOGAMMAGLOBULINEMIA
B CELL ABLATION
COMMON VARIABLE IMMUNODEFICIENCY
INTRAVENOUS IMMUNOGLOBULIN

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From the Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Institute for Cellular Therapeutics, University of Louisville, Louisville, Kentucky, USA.

T.K. Tarrant, MD, Fellow in Rheumatology; D.H. Frazer, MD, Fellow in Allergy and Immunology; D.D. Patel, MD, PhD, Associate Professor of Medicine, Duke University Medical Center; J.P. Aya-ay, BS, Senior Research Assistant, University of Louisville.

Address reprint requests to Dr. T.K. Tarrant, Box 2632, Duke University Medical Center, Durham, NC 27710. E-mail: tarra002@mc.duke.edu

Submitted May 23, 2002; revision accepted August 26, 2002.

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