CEREBRAL SPINAL-FLUID COMPLEMENT AND ANTINUCLEAR AUTO ANTIBODIES IN LUPIC MENINGOENCEPHALITIS

Central nervous system involvement in systemic lupus erythematosus (SL E) requires immediate treatment Whe report a case in a 30-year-old wom an. Clinical features associated asthenia, headache, right nystagmus a nd coma. A mechanical ventilation was started The neurologic pattern a ppeared three months after an initial treatment with pulsed doses of g lucocorticoid (500 mg per day for 3 days) and one month after an oral cyclophosphamid regimen (50 mg twice a week). The cerebral involvement was evidenced by MRI and comparative analysis of the antinuclear auto antibodies (ANA) and the complement components in cerebral spinal flu id (CSF), pleural fluid and serum. The MRI slices showed a well-define d meningeal focal lesion.: CSF-cell count was normal. CSF-proteins wer e elevated. ANA were positive, total complement (Ul/l) was low C4 comp onent (g/l) was 0.11, undetectable and 0.25 respectively in plasma, CS F fluid and pleural fluid The ANA specific pattern was anti-Sm2. We af firmed that specific cerebral injury was present because there were cl inical and imaging features and a decrease of the C3 and C4 component in the CSF. The treatment associated intravenous pulsed doses of methy lprednisolone (1000 mg per days for 3 days) and cyclophosphamid (500 m g per day for three days). Mechanical ventilation was with drawn one d ay after the end of the pulse therapy The diminution of the complement component could help improving cerebral involvement of SLE. More clin ical studies are required.