Sustained clinical stability with telitacicept-containing maintenance therapy following glucocorticoid and IVIG induction for lupus enteritis with autoimmune hemolytic anemia: a case report.

Lupus mesenteric vasculitis (LMV) is a rare but potentially life-threatening complication of systemic lupus erythematosus, with reported mortality rates of up to 13.4% despite aggressive immunosuppression. Standard management relies on high-dose glucocorticoids (GCs) combined with cyclophosphamide (CYC) or mycophenolate mofetil (MMF); however, prolonged glucocorticoid dependence and disease recurrence remain significant clinical challenges. Telitacicept, a recombinant transmembrane activator and calcium-modulating cyclophilin ligand interactor (TACI)-Fc fusion protein that simultaneously neutralizes B-lymphocyte stimulator and a proliferation-inducing ligand, has demonstrated efficacy in active SLE, yet evidence for its use in LMV is limited to a single case report. We describe a 27-year-old female with severe, glucocorticoid-dependent LMV complicated by autoimmune hemolytic anemia (AIHA), who received pulse methylprednisolone (MP) and intravenous immunoglobulin (IVIG) for acute induction, followed by telitacicept 160 mg weekly as part of a combination maintenance regimen. After conventional induction, telitacicept was associated with successful prednisone tapering from 60 mg/day to 10 mg/day over approximately 6 months without disease flare, accompanied by sustained normalization of hemoglobin and complement levels, and radiological improvement. This case represents the second report of telitacicept for LMV and the first to document sustained resolution of AIHA maintained during telitacicept-containing therapy. The induction with pulse MP followed by telitacicept maintenance and accelerated steroid taper" strategy may offer a promising therapeutic option for refractory LMV warranting further prospective investigation.