Page 110 - Abstract Book KONIKA 18

Allergy Immunology

P-AI-015
The Use of Rituximab in Refractory Paediatric Systemic Lupus Erythematosus:
A Single-centre Experience

Edy Novery, Rizqi Amalia, Dina Muktiarti, Nia Kurniati
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital,
Jakarta, Indonesia

Abstract
Background Systemic Lupus Erythematosus (SLE) uses severity and stepwise principle in medication
management. Biologic agent is considered as third line option when standard treatment failed. Rituximab is a
chimerical monoclonal antibody directed against CD20, a molecule specifically expressed by B lymphocytes.
It is expected to provide a significant therapeutic effect in SLE with multi-organ manifestations and refractory
to standard therapy. However we need more information regarding dose, frequency and long-term effect
of this treatment. Objective To report two pediatric refractory SLE patients who got Rituximab in Cipto
Mangunkusumo Hospital. Cases Case 1, a 14-year-old girl, who has been diagnosed with SLE for 2 years.
The patient had severe hematological involvement and had received regular transfusions. She responded
suboptimal to previous therapy, including high dose of steroid, methylprednisolone pulse, azathioprine,
mycophenolic mofetil acid, cyclophosphamide and plasmapheresis. Case 2, a 16-year-old girl, who has been
diagnosed with SLE for 5 years, suffered from hematological, renal involvement, and also glaucoma-induced
steroid. The patient had received high dose of steroid, mycophenolic mofetil acid, hydroxychloroquine and
cyclophosphamide with suboptimal result. We treated both patients with rituximab at a dose of 375 mg/m2
intravenously for 4 cycles with an interval of 1 week. Both patients showed significant clinical improvement,
decreased in SLEDAI score and no serious side effects on 6 month follow up. Conclusion Rituximab has
favorable effects on refractory SLE. We need long-term monitoring to understand the effect, the effective
dosage and the frequency usage of Rituximab in refractory SLE in children.
Keywords: rituximab; refractory; SLE; biologic agent; pediatric

P-AI-016
Clinical Feature and Outcome of Childhood Neuropsychiatric SLE:
Serial Cases

Rivans Jackson Tandirerung, Zahrah Hikmah, Azwin Mengindera Putera L, Anang Endaryanto,
Ariyanto Harsono
Department of Child Health Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Childhood Neuropsychiatric SLE (NP-SLE) had many clinical features, similar to adult NP-SLE
but it usually had poor prognosis with significant morbidity and mortality in children. Objective To present
case series of childhood NP-SLE with variable clinical features. Cases This retrospective study reported serial
cases of childhood NP-SLE observed in the Allergy Immunology Division, Department of Child Health, Dr.
Soetomo General Academic Hospital during 2018-2020. There were six cases of childhood NP-SLE, with
the age of onset was 12-13 years old, including 5 girls and 1 boy. NP-SLE manifestation were seizure (3),
psychotic (1), decrease of consciousness (1), myelopathy (2), movement disorder (3), peripheral neuropathy
(3), headache (3) and mood disorder (1). The diagnosis was confirmed by clinical manifestations and ACR/
SLICC. Head MRI and head CT-scan revealed in normal limit for all patients. One patient had transverse
myelitis from lumbosacral MRI examination and 1 patient with polyradiculopathy from EMG. All patients
had positive result for anti-ds-DNA and ANA test. We treated them with methylprednisolone pulse followed
by oral prednisone for all patient and 5 patients also treated with cyclophosphamide. The clinical conditions
improved for all patient but one patient death after a year evaluation due to lupus flare. Conclusion NP-SLE
in our hospital was relatively rare with multiple clinical features. Early identification and treatment will
resolve the prognosis in childhood NP-SLE.

Keywords: childhood neuropsychiatric SLE; clinical feature; outcome

62 KONIKA XVIII Abstract Book