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Nineteen Episodes of Recurrent Myelitis in a Woman With Neuromyelitis Optica and Systemic Lupus Erythematosus
Sajjad Nasir, MD;
Douglas A. Kerr, MD, PhD;
Julius Birnbaum, MD, MHS
Arch Neurol. 2009;66(9):1160-1163.
Objectives To describe the case of a patient with systemic lupus erythematosus (SLE) and neuromyelitis optica (NMO) who experienced 19 recurrent attacks of myelitis.
Design Case report.
Setting An outpatient neurorheumatology clinic at the Johns Hopkins Hospital devoted to care of patients with neurological manifestation of rheumatic diseases.
Patient A woman with NMO and SLE.
Intervention Rituximab therapy.
Main Outcome Measures Clinical and neuroimaging features of relapsing disease.
Results Recurrent and increasingly severe myelitis attacks still occurred after treatment with rituximab.
Conclusions It may be progressively more difficult to prevent relapses and commensurate disability in patients with later stages of relapsing NMO. Recognition of NMO as a distinct diagnostic entity in patients with SLE and other rheumatic diseases is crucial, in that institution of earlier targeted immunosuppressant treatment may be more effective than later targeted immunosuppression. The cellular arm of the immune system may be recruited by pathogenic B cells and may explain why relapses may occur after treatment with B cell–depleting therapy.
Author Affiliations: Department of Neurology (Drs Nasir, Kerr, and Birnbaum), and Division of Rheumatology, Department of Medicine (Dr Birnbaum), The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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