Cerebral lupus in patients whilst on treatment for lupus nephritis with cyclosporine.

Two young female patients who were treated for severe lupus nephritis with cyclosporine, developed, while the renal parameters remained stable, signs of cerebral lupus (bilateral papiloedema and cranial nerve palsy in one patient and grand mal seizures in the second). The first patient responded to plasmapheresis and i.v. cyclophosphamide, and the second to temporary increase in prednisone with anti-convulsant medication. Both case histories suggest that cyclosporine, whilst controlling lupus nephritis, was not able to prevent serious attacks of cerebral lupus. This discrepancy might be related to relative inability of the drug to reduce antibody production or to the existence of heterogeneous pathogenetic mechanisms of lupus in different organ systems.