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Abstract: TH-PO655

Belimumab-Induced Delirium and Behavioral Changes in a Patient with Lupus Nephritis: A Case Report

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Noor, Sahibzadi, Loma Linda University, Loma Linda, California, United States
  • Mathew, Roy O., Loma Linda University, Loma Linda, California, United States
  • Abdi Pour, Amir, Loma Linda University, Loma Linda, California, United States
  • Norouzi, Sayna, Loma Linda University, Loma Linda, California, United States

Belimumab is a monoclonal antibody against B-lymphocyte stimulator, approved by the United States Food and Drug Administration in 2011 for patients with active systemic lupus erythematosus or active lupus nephritis who are receiving standard therapy. Here, we describe a rare case of a patient developing delirium and behavioral changes after subcutaneous (SC) belimumab initiation.

Case Description

A 65-year-old female with lupus nephritis Class IIIC was started on SC belimumab due to progressive proteinuria while taking prednisone 40 mg daily, mycophenolic acid 180 mg twice daily and hydroxychloroquine 200 mg twice daily. After starting SC belimumab, the patient developed intermittent confusion, forgetfulness and aggressive behavior e.g., inability to recognize her daughter, yelling at others without reason, refusal to go to church despite being an active and regular member previously, and inability to recognize and use common household items. After she threatened to jump out of a moving car when her demands were not met, her husband took her to the emergency room. In the ER, initial laboratory workup and intracranial imaging were unremarkable. Patient was advised to discontinue belimumab and was discharged home. The symptoms resolved completely one to two days after discontinuing SC belimumab. The patient continues to take prior immunosuppressive therapy.


Based on the timing of symptom onset, negative head imaging, unremarkable laboratory workup and immediate resolution after discontinuing belimumab, the symptoms were most likely caused by SC belimumab. She has tolerated both oral and intravenous pulse steroids without any adverse effects, thus ruling out steroids as a possible cause. Literature review showed that intravenous belimumab has been associated with depression, anxiety and suicidality, however, SC belimumab resulted in less psychiatric events than placebo (1). We believe this is the first case of SC belimumab induced delirium and behavioral changes with immediate resolution after cessation. It is important to educate patients and caregivers about such symptoms. This should be verified in post-marketing surveillance of belimumab as well as specific surveillance during clinical trial follow up.