Successful treatment of systemic lupus erythematosus-related severe aseptic meningitis following a switch to dexamethasone: a case-based review.

Aseptic meningitis is a rare neuropsychiatric symptom that may manifest in patients with systemic lupus erythematosus (SLE). The prognosis is generally favorable, with most patients demonstrating a good response to glucocorticoids, such as prednisolone (PSL), and immunosuppressants. Herein, we report a case of severe SLE-associated aseptic meningitis in a 25-year-old woman, who presented with headache and nausea and was admitted to our hospital. The patient was diagnosed with aseptic meningitis, and pulse steroid therapy (methylprednisolone 1 g) was initiated along with PSL 60 mg/day. The patient showed improvements initially, but symptoms relapsed after the PSL dosage was decreased. The patient was readmitted, and pulse steroid therapy (methylprednisolone 1 g) and PSL were administered once again. However, the meningitis remained refractory to both PSL and methylprednisolone, and switching to dexamethasone resulted in an improvement of her symptoms. The patient also received intravenous cyclophosphamide and was discharged from the hospital after successful tapering of dexamethasone. In addition to this report, we also reviewed 25 previously reported cases of SLE-associated aseptic meningitis and compared their clinical characteristics with those of the present case.