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Symptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus: A case
Jiali Chen1, Yuebo Jin, Chun Li
1Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China.
Rationale:
Cyclophosphamide (CY) is an alkylating agent used widely to treat cancer and autoimmune diseases. Hyponatremia is a common adverse effect of high-dose and moderate-dose of intravenous CY, but is rare in patients treated with low-dose (<15 mg/kg).
Patient Concerns:
A 52-year-old woman with new-onset systemic lupus erythematosus (SLE) was treated with low-dose cyclophosphamide (8 mg/kg, CY), but showed sudden headaches, disorientation and weakness. Laboratory examinations revealed severe isovolumic hyponatremia along with low-serum osmolality and high urine osmolality.
Diagnosis:
The acute hyponatremia was consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and was an adverse event of low-dose CY, with no evidence of endocrine, cancer, pulmonary, or cerebral abnormalities relevant to the SIADH.
Intervention:
The hyponatremia was resolved after the supplementation of NaCl solution.
Outcomes:
The hyponatremia was resolved without any complications.
Lessons:
Hyponatremia induced by low-dose CY should be recognized as an underlying life-threatening complication in clinical practice.
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