Rapidly progressing central nervous system involvement despite of steroid pulse therapy in a case of systemic lupus erythematosus presented as mononeuritis multiplex

A 31-year-old-woman with a 6-month history of systemic lupus erythematosus (SLE) was admitted because of severe mononeuritis multiplex. Although she initially responded well with steroid pulse therapy, she developed unconsciousness again 3 weeks later just after a second course of steroid pulse. Laboratory evaluations revealed a high titre of anti-DNA antibody, low complement levels, and positive lupus anticoagulant. She was treated with intravenous cyclophosphamide pulse therapy with immediate response. The clinical course of central nervous system involvement was very unusual for the response to steroid pulse therapy.