Fig. 3

Treatment and prognosis. MP alone at the dose of 20 mg/d and 40 mg/d were given orally for the first and second month, but without efficacy. Anti-IL-6 receptor antibody (tocilizumab) treatment was started based on the result of elevated serum IL-6, at 4062 pg/mL, and given in a total of five sessions at 3–4-week interval. The serum IL-6 level returned to normal after the first dose of 480 mg, remained normal after the second dose of 480 mg, rebounded after tocilizumab was reduced to 80 mg at the third dose and returned to normal after the fourth and the fifth doses of 480 mg tocilizumab. As the serum IL-6 level decreased, the 24 h urinary protein level returned to the normal range, and edema, fever, polyserositis, serum albumin improved. CyS was added orally at the dose of 150 mg/week after tocilizumab was stopped and MP tapered. The IL-6 level, blood and urine tests and clinical manifestations all remained normal at the follow-up of 1 year after discharge with oral MP of 2 mg/day and CyS of 50 mg/week. IL: Interleukin; MP: methylprednisolone; 24-UTP: 24 h urine total protein; TCZ: tocilizumab; CyS: cyclophosphamide