Immunoablative Cyclophosphamide for Refractory Lupus-Related Neuromyelitis Optica
CHI CHIU MOK, CHI HUNG TO, ANSELM MAK, and WAI LUN POON
ABSTRACT.
Neuromyelitis optica (NMO), or Devic's disease, is an aggressive inflammatory disease of the central nervous system that predominantly affects the optic nerves and the spinal cord. The association with other systemic autoimmune diseases and the discovery of the specific biomarker, NMO-immunoglobulin G (IgG), suggests that NMO is autoimmune in origin. The prognosis of NMO is grave, especially in those patients with early and recurrent relapses. We describe successful use of immunoablative cyclophosphamide in halting relapses in a patient with systemic lupus erythematosus-associated NMO who was unresponsive to high-dose oral and intravenous corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, tacrolimus, low-dose daily oral cyclophosphamide and rituximab. (J Rheumatol 2008;35:172-4)
Key Indexing Terms:
NEUROMYELITIS OPTICA
LUPUS
TREATMENT
TRANSPLANT
IMMUNOABLATIVE
CYCLOPHOSPHAMIDE
From the Department of Medicine and Radiology, Tuen Mun Hospital, Hong Kong SAR.
C.C. Mok, MD, FRCP; C.H. To, MB, MRCP, Fellow in Rheumatology;
A. Mak, MB, MRCP, Fellow in Rheumatology, Department of Medicine; W.L. Poon, MB, FRCR, Senior Radiologist, Department of Radiology, Tuen Mun Hospital.
Address reprint requests to Dr. C.C. Mok, Department of Medicine, Tuen Mun Hospital, Hong Kong SAR. E-mail: ccmok2005@yahoo.com
Accepted for publication September 6, 2007.
