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Case Report
Mycophenolate Mofetil and Intravenous Dexamethasone in the Treatment of Persistent
Lupus Myelitis
PAOLA TOMIETTO, SERENA D'AGOSTINI, VIRGINIA ANNESE, SALVATORE De VITA, and GIANFRANCO FERRACCIOLI ABSTRACT. Methylprednisolone and cyclophosphamide pulse therapies are the most commonly used for transverse myelopathy in neuropsychiatric lupus. Little is known about the efficacy of other immunosuppressors. We describe the case of a 33-year-old woman with systemic lupus erythematosus, who developed a tranverse myelopathy, beginning with a hiccup due to involvement of the medulla oblongata; despite pulses of methylprednisolone plus azathioprine and cyclosporine therapy, she developed paraparesis with involvement of the cervical spine cord. After oral cyclophosphamide, the lesion remained active. Subsequent therapy with mycophenolate mofetil and continuous intravenous infusions of dexamethasone resulted in reduction of the lesion's size, disappearance of magnetic resonance imaging enhancement, and a complete recovery. (J Rheumatol 2007;34:588-91) Key Indexing Terms:
TRANSVERSE MYELITIS From the Division of Rheumatology, University of Udine; Neuroradiology Department and Division of Neurology–University and S. Maria della Misericordia Hospital, Udine; and Division of Rheumatology, Catholic University of Rome, Rome, Italy. P. Tomietto, MD; S. De Vita, MD, Division of Rheumatology, University of Udine; S. D'Agostini, MD, Neuroradiology Department–S. Maria della Misericordia Hospital; V. Annese, MD, Division of Neurology–University and S. Maria della Misericordia Hospital; G. Ferraccioli, MD, Division of Rheumatology, Catholic University of Rome. Address reprint requests to Prof. G.F. Ferraccioli, Division of Rheumatology, UCSC, School of Medicine, Complesso Integrato Columbus, Via Moscati 31, 00168, Rome, Italy. E-mail: gf.ferraccioli@rm.unicatt.it Accepted for publication October 13, 2006.
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