A Female With Systemic Lupus Erythematosus and Streptococcal Pneumonia Treated With Intravenous Immunoglobulins (Ivig)

The systemic lupus erythematosus (SLE) is a complex autoimmune disorder with a wide array of clinical manifestations, including chest infections. S. aureus is the most common bacteria that cause infectious pneumonia in SLE. Other bacteria, such as S. pneumoniae has been implicated as a cause of lung infection. In this study we aimed to use intravenous immunoglobulins (IVIG) as only immunotherapy for the management of a SLE in a Hispanic woman. Laboratory investigations for the diagnosis of SLE were done including the detection of anti-nuclear antibodies (ANA) and SLE confirmation by the detection of high titers of anti-dsDNA antibodies. Serum levels of C3 and C4 were assessed as well as quantification of immunoglobulins. The SLEDAI score was measured to determine whether a significant degree of disease activity existed and as prognostic value. The evaluation of the chest infection was performed by chest-X-ray at the beginning and after treatment. She was treated with 10 g/day of IVIG for six consecutive days and thereafter 10 g/monthly. The immunological evaluation demonstrated that this patient presented with a flare of SLE during a pneumococcal pneumonia. Hight titers of ANA and anti-dsDNA antibodies were detected as well as low C3 and C4, and elevated levels of immunoglobulins. The SLEDAI score fall from 10 to below 3 and the chest infection cleared up. IVIG treatment was effective in the treatment of a pneumonia associated SLE crisis. IVIG demonstrated once more that can be used as immunosuppressor, immunomodulator, and anti-microbial in patients with SLE, avoiding the use of steroids.