Pulse cyclophosphamide decreases sympathetic postganglionic activity, controls alveolitis, and normalizes vascular tone dysfunction (Raynaud's phenomenon) in a case of early systemic sclerosis

In systemic sclerosis (SSc), alterations of the autonomic nervous system are detectable in different organs (cardiovascular and gastrointestinal system) even before the skin involvement becomes evident (prescleroderma) (1). It is still a matter of research whether the neurovegetative alteration may be the trigger of the disease itself or rather the earliest consequence of a vascular derangement of the main internal organs. Nothing is known about the relationship between lung involvement (alveolitis)-one of the earliest and most frequent alterations-and sympathetic activity. In SSc, a significant correlation between indirect indices of cardiac sympathetic activity and lung dysfunction has been found (2). Microneurography evaluates the activity of the autonomic nervous system in awake humans through intraneural recordings of the sympathetic postganglionic vasomotor activity to muscles (MSNA) (3). Although the treatment for SSc is not fully established, cyclophosphamide (CYC), either by oral (4) or pulsed modality (5), has been recently proposed as an effective treatment to control lung alveolitis in SSc. We report the case of a patient affected by early SSc who presented with Raynaud's phenomenon and alveolitis paralleled by an increase in MSNA. The successful control of alveolitis by CYC was followed by a reduction in MSNA and disappearance of Raynaud's phenomenon attacks