Sjogren's syndrome-associated meningoencephalomyelitis: Cerebrospinal fluid cytokine levels and therapeutic utility of tacrolimus

Takayuki Hoshina, Yui Yamaguchi, Shouichi Ohga, Ryutaro Kira, Masataka Ishimura, Hidetoshi Takada, Tamami Tanaka, Toshiro Hara

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Serial changes in the circulating and cerebrospinal fluid (CSF) cytokine levels were assessed in a patient with Sjogren's syndrome (SS)-associated meningoencephalomyelitis. A 16-yr-old girl diagnosed as having primary SS at 8 yr of age presented headache and vomiting. CSF studies revealed lymphocyte-dominant pleocytosis and high IgM index, but no evidence of infection. Disturbed consciousness and diffuse slow waves on electroencephalogram led to the diagnosis of SS-meningoencephalitis. The clinical condition subsided after a cycle of dexamethasone therapy, however, 2 months later urinary retention and paresthesia of the lower body developed. Craniospinal magnetic resonance imaging (MRI) showed extensive intraparenchymal lesions with high T2-weighted signal intensity adjacent to the posterior left horn of lateral ventricle of the brain and the longitudinal lesion from C5 to T10 of the spinal cord. High-dose methyl-prednisolone and subsequent tacrolimus therapy has effectively controlled the activity of SS-meningoencephalomyelitis. Monitoring of systemic and CSF cytokine levels during the course of illness revealed that CSF interleukin-6, but not interferon-γ or tumor necrosis factor-α levels were the sensitive indicator of disease activity. The unique cytokine profile, differing from those of infectious meningitis may be useful for predicting the central nervous system involvement in autoimmune disease.

Original languageEnglish
Pages (from-to)182-186
Number of pages5
JournalJournal of the Neurological Sciences
Volume267
Issue number1-2
DOIs
Publication statusPublished - Apr 15 2008

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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