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Lupus activation with cerebritis following pegylated interferon in a hemodialysis patient


Background. A 20-year-old female patient with chronic hepatitis C virus infection and end-stage renal disease due to systemic lupus erythematosus was admitted to hospital with fever, pain in the abdomen, seizures and an alteration of consciousness. The patient was on maintenance dialysis and was receiving pegylated interferon monotherapy for her chronic hepatitis C virus infection.

Investigations. Physical examination, laboratory tests including complete blood count and measurement of serum electrolyte levels, CT scans of the head and abdomen, MRI of the brain, microscopic examination of the cerebrospinal fluid, chest X-ray, echocardiography and measurement of C3 complement and anti-double-stranded DNA antibody levels.

Diagnosis. Activation of systemic lupus erythematosus with cerebritis following pegylated interferon therapy.

Management. Intravenous fluid, intermittent oxygen, intravenous diphenylhydantoin, intravenous pulse methylprednisolone 500 mg for 3 days followed by 40 mg per day of oral prednisolone, and temporary withdrawal of pegylated interferon.

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Figure 1: CT scan of the abdomen on hospital admission showing jejunal wall thickening (arrow) with features of ileus and mild ascites.
Figure 2: Chest X-ray showing cardiomegaly on hospital admission.


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Correspondence to Sanjay Kumar Agarwal.

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Agarwal, S., Lal, C. & Zaidi, S. Lupus activation with cerebritis following pegylated interferon in a hemodialysis patient. Nat Rev Nephrol 5, 599–603 (2009).

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