Anifrolumab as a glucocorticoid-sparing agent in MRI-negative myelitis associated with neuropsychiatric lupus: A case report.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organs, including the kidneys, skin, vasculature, and central nervous system. Neuropsychiatric SLE (NPSLE) is a potentially life-threatening manifestation with diverse clinical presentations. We report a case of NPSLE presenting as myelitis in which contrast-enhanced spinal MRI showed no intramedullary abnormalities on repeated examinations ('MRI-negative myelitis'). The patient received high-dose intravenous glucocorticoids (GCs) and intravenous cyclophosphamide as induction therapy, after which anifrolumab was introduced; GCs were rapidly tapered with sustained neurological improvement. MRI-negative myelitis is a rare and diagnostically challenging NPSLE phenotype that requires a high index of suspicion. This case suggests that anifrolumab may have GC-sparing potential as part of maintenance management following induction therapy in selected patients, warranting further investigation.