Increased myo-inositol in parietal white and gray matter as a biomarker of poor prognosis in neuropsychiatric lupus: a case report.
Neuropsychiatric manifestations can be a serious complication of systemic lupus erythematosus, affecting nearly 56% of these patients. Frequently, acceptable clinical outcome is observed in neurolupus with immunosuppressive therapy. Different metabolites identified with MR spectroscopy may be associated with modifications in the natural history of this disease, specifically in the central nervous system. We report a case of neurolupus with progressive neurologic impairment despite aggressive immunosuppressive treatment. We describe clinical features, laboratory and MRI results, as well as characteristic findings on MR spectroscopy. Serial MRI identified atrophy of the left temporal lobe. MR spectroscopy showed an increase of myo-inositol/creatine ratio intensity, accompanied by a decrease of N-acetylaspartate/creatine ratio in both parietal white and gray matter. During follow-up, the patient developed progressive cognitive deficiency despite the intensification of therapy. Neurolupus manifestations are common and immunosuppressive treatment often avoids severe complications. Characteristic findings on MR spectroscopy may be useful for clinicians to determine poor prognosis and resistance to therapy.
['Guillen-Del Castillo|A|A|', 'Alonso|J|J|', 'Martínez-Valle|F|F|', 'Alonso-Vila|S|S|', 'Garrido-Castro|A C|AC|', 'Vilardell-Tarrés|M|M|', 'Rovira|Á|Á|', 'Ordi-Ros|J|J|']
D001284:Atrophy D015415:Biomarkers D003071:Cognition D018450:Disease Progression D005260:Female D066128:Gray Matter D006801:Humans D007166:Immunosuppressive Agents D007294:Inositol D020945:Lupus Vasculitis, Central Nervous System D008279:Magnetic Resonance Imaging D008875:Middle Aged D010296:Parietal Lobe D066244:Proton Magnetic Resonance Spectroscopy D013702:Temporal Lobe D013997:Time Factors D015854:Up-Regulation D066127:White Matter
myo-inositol Neuropsychiatric lupus systemic lupus erythematosus N-acetylaspartate cognitive impairment proton magnetic resonance spectroscopy