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Title: Mycophenolate Mofetil is Potential Treatment Option for Pulmonary Haemorrhage in Childhood Systemic Lupus Erythematosus

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South Med J 2003 Jul;96:7:705-7.
10/07/2003 09:29:00 AM
By Deanna M Green, PhD

Mycophenolate mofetil treatment of pulmonary haemorrhage resulted in serologic and clinical improvement in a child with systemic lupus erythematosus (SLE) who did not respond to standard steroid or cyclophosphamide therapy, according to a recent American case study. Pulmonary haemorrhage is a potentially fatal complication associated with SLE. Typical treatment for pulmonary haemorrhage in these patients is high dose corticosteroids, with or without concomitant cytotoxic agents, such as cyclophosphamide. Mycophenolate mofetil, another potential therapy, has been used in adults to treat lupus nephritis, psoriasis, rheumatoid arthritis, and inflammatory eye disease. Its effectiveness in children, however, has yet to be evaluated. Ahmed S. Samad, MD, and Carol B. Lindsley, MD, at the University of Kansas Medical Centre, United States, described the use of mycophenolate mofetil in the treatment of pulmonary haemorrhage in a child with SLE. The case study was a 14-year-old boy of Mexican descent who had been diagnosed with lupus nephritis 2 years earlier. The patient presented with fatigue, abdominal pain, and arthritis after finishing his several weeks of prednisone. Further examination also revealed leucopoenia, anaemia, seizure disorder, pulmonary haemorrhage, and renal insufficiency. Standard treatment with intravenous methylprednisone and pulse cyclophosphamide was administered, but was ineffective. Furthermore, no clinical improvement was seen with plasmapheresis and intravenous immunoglobulin treatment. Mycophenolate mofetil treatment (500 mg intravenous, twice daily) was initiated to control diffuse pulmonary vasculitis. Concomitant hydroxychloroquine (200 mg, twice daily) and methylprednisolone (40 mg IV, bid) were also given. Fifteen days later, serologic improvement was observed as serum complement levels rose and anti-dsDNA antibody levels dropped. Furthermore, after 3 weeks of treatment, total haemolytic complement (CH50) values finally normalised. The authors conclude that "mycophenolate mofetil is an additional potential resource to the armamentarium in the treatment of severe SLE and its complications." They further recommend that "it should be considered as an option in selecting long-term immunosuppressive therapy for patients with SLE, especially those who cannot tolerate cyclophosphamide therapy or whose condition failed to improve while taking cyclophosphamide.

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