Macrophage activation syndrome triggered by systemic lupus erythematosus flare: successful treatment with a combination of dexamethasone sodium phosphate, intravenous immunoglobulin, and cyclosporine: a case report

Wesam Gouda*, Faisal Alsaqabi, Abdelhfeez Moshrif, Awad S. Abbas, Tarek M. Abdel-Aziz, Md Asiful Islam

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
62 Downloads (Pure)

Abstract

Background: Macrophage activation syndrome is classified as a secondary form of hemophagocytic lymphohistiocytosis. It is a hyperinflammatory complication observed to be comorbid with a variety of autoimmune diseases, including adult-onset Still’s disease and systemic juvenile idiopathic arthritis. Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus, which, if untreated, can be fatal, though determining the optimum treatment strategy is still a challenge.

Case presentation: Herein, we report a case of macrophage activation syndrome in a 33-year-old Egyptian female as an unusual complication of a systemic lupus erythematosus flare in adult patients. Our patient was initially treated with a combination of intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy, which was followed by a course of oral prednisolone and oral cyclosporine with little response. Switching from oral prednisone to intravenous dexamethasone sodium phosphate showed a more favorable clinical and biochemical response.

Conclusion: Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus. Our case demonstrates that dexamethasone sodium phosphate can be a successful alternative treatment for patients with systemic lupus erythematosus complicated by macrophage activation syndrome in whom the response to pulse methylprednisolone was inadequate to manage their illness, proving to be remarkably effective in a relatively short time frame.

Original languageEnglish
Article number497
Number of pages6
JournalJournal of medical case reports
Volume15
Issue number1
Early online date7 Oct 2021
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
None.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Cyclosporine
  • Dexamethasone sodium phosphate (DSP)
  • Hemophagocytic lymphohistiocytosis (HLH)
  • Intravenous immunoglobulin (IVIG)
  • Macrophage activation syndrome (MAS)
  • Systemic lupus erythematosus (SLE)

ASJC Scopus subject areas

  • General Medicine

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