Successful treatment of systemic lupus erythematosus cerebritis with intravenous immunoglobulin

Neuropsychiatric lupus includes extremely diverse clinical manifestations, ranging from mild cognitive dysfunction to a severe,. life-threatening pres entation. We report a 28-year-old patient with systemic lupus erythematosus who had persistent fever for 3 months, and developed within a few hours mo tor and sensory aphasia, rotator nystagmus with deviation of the eyes,and s evere nuchal rigitidy. An extensive series of imaging and laboratory tests were interpreted as normal, except for an elevated opening pressure at lumb ar puncture, cerebrospinal fluid inflammatory findings, and asymmetrical co rtical perfusion on single-photon emission computed tomography. The patient received one course of high-dose intravenous immunoglobulin (IVIg) and wit hin 5 days her condition returned to that of 3 months before admission. The mechanisms of injury, along with the management of cerebral lupus and the mechanisms of action of IVIg, are discussed.