Treatment options in severe progressive systemic lupus erythematosus (SLE) are limited and associated with serious potential side effects, such as cytotoxicity, immunosuppression or metabolic imbalances. As SLE is characterised by quantitative and qualitative abnormalities of B cell functions, we reasoned that a combination of extracorporeal therapy (immunoadsorption)¹ with a monoclonal antibody (mAb) to CD20 to deplete the circulating B cell pool^2–4 might be beneficial in the treatment of refractory severe SLE.

A 49 year old white man who was diagnosed for SLE with primary renal, cardiac, and pulmonary disease in 1989, presented in August 2004. The disease was highly active (European Consensus Lupus Activity Measurement (ECLAM) score 5, pancytopenia, raised anti-dsDNA antibodies, markedly …