Júnior Jucier Gonçalves, Teixeira Bicalho Maria Eugenia, Noronha Guedes Lissiane Karine, Gallucci-Neto Jose, Pereira Rosa M R
Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil.
ECT Service, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil.
Psychiatry Clin Psychopharmacol. 2022 Mar 1;32(1):93-95. doi: 10.5152/pcp.2022.21267. eCollection 2022 Mar.
The use of electroconvulsive therapy in case of catatonia due to systemic lupus erythematosus refractory in treatment with immunosuppressant is rare. Therefore, we report a case of catatonia due to systemic lupus erythematosus treated with electroconvulsive therapy as an adjuvant to cyclophosphamide treatment. A 34-year-old female patient diagnosed with systemic lupus erythematosus attended the rheumatology outpatient clinic with a history of catatonia for 8 weeks and laboratory tests revealed high titers of anti-ds DNA positive anti-RNP and polyclonal gammopathy. cyclophosphamide pulse therapy was scheduled in association with electroconvulsive therapy, in 12 sessions, twice a week. The patient evolved with significant clinical improvement after 6 sessions of electroconvulsive therapy and 2 pulses of cyclophosphamide, with negative anti-ds DNA and normalization of gamma globulin levels. Thus, electroconvulsive therapy should be considered as adjuvant therapy in severe cases of neuropsychiatric systemic lupus erythematosus, including catatonia, especially in those with relapses and poor response to immunosuppressant and psychotropic drugs.
在系统性红斑狼疮所致紧张症用免疫抑制剂治疗无效的情况下使用电休克疗法的情况很少见。因此，我们报告一例系统性红斑狼疮所致紧张症患者，用电休克疗法作为环磷酰胺治疗的辅助手段。一名34岁女性患者，诊断为系统性红斑狼疮，因紧张症病史8周就诊于风湿病门诊，实验室检查显示抗双链DNA、抗核糖核蛋白抗体高滴度阳性及多克隆丙种球蛋白病。计划将环磷酰胺脉冲疗法与电休克疗法联合应用，共12次，每周两次。在进行6次电休克疗法和2次环磷酰胺脉冲治疗后，患者临床症状显著改善，抗双链DNA转阴，γ球蛋白水平恢复正常。因此，电休克疗法应被视为重症神经精神性系统性红斑狼疮（包括紧张症）的辅助治疗方法，尤其是在那些复发且对免疫抑制剂和精神药物反应不佳的患者中。
