J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 8, Number 7, July 2016, pages 555-559

Systemic Lupus Erythematosus With Acute Inflammatory Demyelinating Polyneuropathy: A Case Report and Review of the Literature

Figure 1. Histologic features of section of kidney biopsy. Glomerular mesangial proliferation with focal endothelial cell proliferation. (A) H&E, × 400; (B) PASM, × 400; (C) Masson, × 400; (D) Gomori methenamine silver (GMS), × 400.

**Table 1.** Electrophysiological Findings
	Lat (SD), ms	Amp (SD), mV	CV (SD), m/s	Amp (SD), %
Motor nerve
Right medianus
Wrist-APB	4.5 (3.9)	0.2 (-2.7)
Elbow-wrist	9.5	0.2	35.4	34
Left ulnaris
Wrist-ADM	3.8 (-6.2)	0.1 (-4.5)
Ab elbow-wrist	8.5	0.6	47.8 (-1.7)	435 (52)
Right tibialis
Ankle-AHB	9.4 (15.7	0.1
PF-ankle	25.7	0.1	23.4	351
Left tibialis
Ankle-AHB	9.0 (14.6)	0.0
PF-ankle	24.0	0.1	27.3	352
Right peroneus
Ankle-EDB	7.9 (8.3)	0.2 (-2.1)
CF down-ankle	17.0	0.2	34.2	3
Left peroneus
Ankle-EDB	9.0 (9.8)	0.1 (-2.1)
CF down-ankle	18.7	0.3	32.4	415
Sensory nerve
Right medianus
Dig II-wrist	2.6 (-0.7)	16	53.7
Left ulnaris
Dig V-wrist	2.8 (0.1)	12	46.5
Right peroneus super
Ankle-foreleg	4.1	4.0	35.0 (-3.2)
Left peroneus super
Ankle-foreleg	3.9	5.9	33.4 (-3.6)

Table 1. Electrophysiological Findings

Lat (SD), ms

Amp (SD), mV

CV (SD), m/s

Amp (SD), %

Motor nerve

Right medianus

Wrist-APB

4.5 (3.9)

0.2 (-2.7)

Elbow-wrist

9.5

0.2

35.4

Left ulnaris

Wrist-ADM

3.8 (-6.2)

0.1 (-4.5)

Ab elbow-wrist

8.5

0.6

47.8 (-1.7)

435 (52)

Right tibialis

Ankle-AHB

9.4 (15.7

0.1

PF-ankle

25.7

0.1

23.4

351

Left tibialis

Ankle-AHB

9.0 (14.6)

0.0

PF-ankle

24.0

0.1

27.3

352

Right peroneus

Ankle-EDB

7.9 (8.3)

0.2 (-2.1)

CF down-ankle

17.0

0.2

34.2

Left peroneus

Ankle-EDB

9.0 (9.8)

0.1 (-2.1)

CF down-ankle

18.7

0.3

32.4

415

Sensory nerve

Right medianus

Dig II-wrist

2.6 (-0.7)

53.7

Left ulnaris

Dig V-wrist

2.8 (0.1)

46.5

Right peroneus super

Ankle-foreleg

4.1

4.0

35.0 (-3.2)

Left peroneus super

Ankle-foreleg

3.9

5.9

33.4 (-3.6)

**Table 2.** Previous Reports About GBS or AIDP With SLE
Author	Age/sex	GBS and SLE	Organ involvement	Auto-Ab(+)	Treatment (effect +, -)
PE: plasma exchange; IVIG: intravenous immunoglobulin; ANA: antinuclear antibody; anti-dsDNA: anti-double-stranded DNA; anti-SS-A: anti-Ro antibodies; anti-SS-B: anti-La antibodies; AHA: anti-histone antibodies; ACA: anti-cardiolipin antibodies; PNS: peripheral nervous system; anti-Smith: anti-Smith antibodies.
Hsu et al [18]	28/F	Early	PNS, pleurisy, lymphopenia	ANA, anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B	Prednisolone, PE, (+)
Chaudhuri et al [20]	40/M	Early	PNA, lymphopenia, seizure, membranous glomerulonephritis	ANA, anti-dsDNA	Prednisolone, cyclophosphamide, PE, (+)
Santiago-Casas et al [22]	20/F	Early	PNA, lymphopenia, proteinuria	ANA, anti-dsDNA	Cyclophosphamide, glucocorticoids, PE, IVIG, (+)
Santiago-Casas et al [22]	34/F	Early	PNS, arthritis, lymphopenia	ANA, anti-dsDNA	Glucocorticoids, IVIG, cyclophosphamide, (+)
Miyagawa et al [13]	9/F	Late	PNS, chilblain or erythema multiforme, oral ulcers	ANA, anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B	Corticosteroids, PE, IVIG, (+)
Robson et al [23]	33/F	Early	Hemolytic anemia, thrombocytopenia, retinal vasculitis, PNS, CNS	ANA, anti-dsDNA	Glucocorticoids, cyclophosphamide, (+)
Vaidya et al [16]	23/M	Early	PNS, WHO class V lupus nephropathy	ANA, anti-dsDNA	Glucocorticoids, cyclophosphamide, PE, (+)
Millette et al [21]	23/F	Early	PNS, cranial nerve	ANA, anti-dsDNA, anti-Smith, anti-RNP	Glucocorticoids, (+)
Okoh et al [8]	41/F	Early	Leukopenia, pericardial and pleural effusions, proteinuria, and hematuria	ANA, anti-dsDNA, anti-Smith	Cyclophosphamide, glucocorticoids, PE, IVIG, mycophenolate mofetil, (+)
van Laarhoven et al [19]	20/F	Early	Facial exanthema pleural and pericardial, proteinuria, autoimmune hemolytic anemia	ANA, anti-Smith, anti-RNP	IVIG, cyclophosphamide, glucocorticoids, (+)
Rajadhyaksha et al [17]	30/F	Early	Oral ulcers, arthralgias, bulbar palsy, cranial nerve, class II mesangio proliferative lupus nephritis nerve	ANA, anti-dsDNA, anti-Smith, GT1a, GQ1b, GM1b	IVIG, glucocorticoids, (+)
Ha-Ou-Nou et al [11]	44/M	Early	Lymphopenia, proteinuria, thrombocytopenia	anti-dsDNA	Corticosteroids, IVIG, (-)
Stahl et al [14]	56/F	Early	Thrombocytopenia, stomatitis, hair loss, arthritis	ANA, AHA	IVIG, cyclophosphamide, corticosteroids, (-)
Lewis and Gibson [12]	21/M	Late	Arthritis, pleuro-pericarditis, proteinuria	ANA, anti-dsDNA, anti-RNP, ACA	Cyclophosphamide, IVIG, prednisolone, (+)
Yildiz et al [9]	47/F	Late	Discoid rash, photosensitivity, oral ulcers, leucopenia, lymphopenia	ANA	Corticosteroid, cyclophosphamide, (+)
Matsuki et al [15]	61/F	Early	Arthritis, oral ulcers, pericarditis, lymphopenia	ANA, anti-dsDNA, anti-Ro/SS-A, anti-GMl	Methylprednisolone, mizoribine, immunoadsorption, PE, (+)

Table 2. Previous Reports About GBS or AIDP With SLE

Author

Age/sex

GBS and SLE

Organ involvement

Auto-Ab(+)

Treatment (effect +, -)

PE: plasma exchange; IVIG: intravenous immunoglobulin; ANA: antinuclear antibody; anti-dsDNA: anti-double-stranded DNA; anti-SS-A: anti-Ro antibodies; anti-SS-B: anti-La antibodies; AHA: anti-histone antibodies; ACA: anti-cardiolipin antibodies; PNS: peripheral nervous system; anti-Smith: anti-Smith antibodies.

Hsu et al [18]

28/F

Early

PNS, pleurisy, lymphopenia

ANA, anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B

Prednisolone, PE, (+)

Chaudhuri et al [20]

40/M

Early

PNA, lymphopenia, seizure, membranous glomerulonephritis

ANA, anti-dsDNA

Prednisolone, cyclophosphamide, PE, (+)

Santiago-Casas et al [22]

20/F

Early

PNA, lymphopenia, proteinuria

ANA, anti-dsDNA

Cyclophosphamide, glucocorticoids, PE, IVIG, (+)

Santiago-Casas et al [22]

34/F

Early

PNS, arthritis, lymphopenia

ANA, anti-dsDNA

Glucocorticoids, IVIG, cyclophosphamide, (+)

Miyagawa et al [13]

9/F

Late

PNS, chilblain or erythema multiforme, oral ulcers

ANA, anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B

Corticosteroids, PE, IVIG, (+)

Robson et al [23]

33/F

Early

Hemolytic anemia, thrombocytopenia, retinal vasculitis, PNS, CNS

ANA, anti-dsDNA

Glucocorticoids, cyclophosphamide, (+)

Vaidya et al [16]

23/M

Early

PNS, WHO class V lupus nephropathy

ANA, anti-dsDNA

Glucocorticoids, cyclophosphamide, PE, (+)

Millette et al [21]

23/F

Early

PNS, cranial nerve

ANA, anti-dsDNA, anti-Smith, anti-RNP

Glucocorticoids, (+)

Okoh et al [8]

41/F

Early

Leukopenia, pericardial and pleural effusions, proteinuria, and hematuria

ANA, anti-dsDNA, anti-Smith

Cyclophosphamide, glucocorticoids, PE, IVIG, mycophenolate mofetil, (+)

van Laarhoven et al [19]

20/F

Early

Facial exanthema pleural and pericardial, proteinuria, autoimmune hemolytic anemia

ANA, anti-Smith, anti-RNP

IVIG, cyclophosphamide, glucocorticoids, (+)

Rajadhyaksha et al [17]

30/F

Early

Oral ulcers, arthralgias, bulbar palsy, cranial nerve, class II mesangio proliferative lupus nephritis nerve

ANA, anti-dsDNA, anti-Smith, GT1a, GQ1b, GM1b

IVIG, glucocorticoids, (+)

Ha-Ou-Nou et al [11]

44/M

Early

Lymphopenia, proteinuria, thrombocytopenia

anti-dsDNA

Corticosteroids, IVIG, (-)

Stahl et al [14]

56/F

Early

Thrombocytopenia, stomatitis, hair loss, arthritis

ANA, AHA

IVIG, cyclophosphamide, corticosteroids, (-)

Lewis and Gibson [12]

21/M

Late

Arthritis, pleuro-pericarditis, proteinuria

ANA, anti-dsDNA, anti-RNP, ACA

Cyclophosphamide, IVIG, prednisolone, (+)

Yildiz et al [9]

47/F

Late

Discoid rash, photosensitivity, oral ulcers, leucopenia, lymphopenia

ANA

Corticosteroid, cyclophosphamide, (+)

Matsuki et al [15]

61/F

Early

Arthritis, oral ulcers, pericarditis, lymphopenia

ANA, anti-dsDNA, anti-Ro/SS-A, anti-GMl

Methylprednisolone, mizoribine, immunoadsorption, PE, (+)