A Challenging Diagnosis of Systemic Lupus Erythematosus with Status Epilepticus

Iftikhar, Pulwasha M; Munawar, Maham; Hasan, Choudhary Ahmed; Faisaluddin, Mohammed; Cohen, Aly

doi:10.7759/cureus.4783

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…In one study, seizures presented with an interval of 0.14 (−0.50 to 7.57) years from the time of SLE diagnosis to the first seizure. In rare circumstances, status epilepticus may be the initial presenting symptom [13,14] and epilepsy may appear years before the diagnosis, as was the case in our patient [12,15]. It remains unclear if NPSLE and epileptic seizures in our patient were related; we believe seizures were part of NPSLE since the post-ictal psychosis was rapidly aborted by steroids and HCQ.…”

Section: Discussionmentioning

confidence: 59%

A Wolf in Hiding: Epilepsy and Post-ictal Psychosis As Unrecognized Presenting Features of Systemic Lupus Erythematosus

Akkol¹,

Shapira²,

Seay³

et al. 2022

Cureus

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems. Many patients present with neurological and psychiatric signs and symptoms at some point in the course of the disease. Here, we present a patient with neuropsychiatric SLE (NPSLE) who presented with longstanding and difficult-to-control epileptic seizures and post-ictal psychotic symptoms prior to the diagnosis of SLE. A 39-year-old patient with a ten-year history of uncontrolled epileptic seizures despite multiple medications and recent diagnosis of chronic kidney disease presented to the emergency department following multiple witnessed seizures. Her seizures were controlled following initial interventions and the patient was admitted to the hospital to control metabolic acidosis and hyperkalemia. Later, the patient developed psychosis with auditory hallucinations, combative behavior, and agitation which were controlled with restraints and sedatives. Initial serological and urinary studies revealed disturbances of multiple systems and triggered broad workup resulting in positive serological SLE markers. The patient was then started on immunosuppressive medications with prompt control of post-ictal psychosis. The patient was discharged with immunosuppressive regimen and control of her seizures. This case highlights that signs and symptoms of NPSLE may appear before the onset of SLE diagnosis. Additionally, our patient had longstanding epilepsy with post-ictal psychosis, which has not been reported in the literature before. We believe this case highlights the challenges in the diagnosis of NPSLE, the rapid control of seizures and/or psychosis with SLE treatment, and the necessity to broaden the differential diagnosis in atypical presentation of seizures and/or psychosis.

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Section: Discussionmentioning

confidence: 59%

A Wolf in Hiding: Epilepsy and Post-ictal Psychosis As Unrecognized Presenting Features of Systemic Lupus Erythematosus

Akkol¹,

Shapira²,

Seay³

et al. 2022

Cureus

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“…After that, the patient had clinical improvement in terms of symptoms and radiology. Another case was reported by (Iftikhar, et al, 2019), a 43-year-old female who presented to the emergency department with a seizure. She failed conventional antiepileptic medications, and Later on, she developed a malar rash which then the diagnosis of SLE was established based on refractory positive ANA, arthritis, malar rash, and seizures.…”

Section: Discussionmentioning

confidence: 99%

Seizure as Initial Manifestation of SLE , CASE REPORT

Khormi,

HIJAZI

2024

Preprint

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with variable disease courses and multiple clinical manifestations [1]. The etiology of SLE is not clear, but different environmental (ultraviolet [UV] light, infections, drugs), genetic, and hormonal factors all seem to be involved [1]. Positive family history and history of having other autoimmune illnesses are considered high-risk factors for SLE, but most SLE cases are scattered [1]. The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as a mandatory entry criterion; followed by additive weighted standards grouped in seven clinical (constitutional, hematological, neuropsychiatric, serosal, musculoskeletal, renal, mucocutaneous ) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10, and patients accumulating ≥10 points are classified to have SLE [2]. Herein, we report this case of neuropsychiatric lupus as it is uncommon and is a severe form of SLE.

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“…Thereafter, the patient exhibited clinical improvement in terms of symptoms and radiology. Another case reported by Iftikhar et al 5 involved a 43‐year‐old woman who presented to the emergency department with a seizure. The patient was refractory to conventional antiepileptic medications and later developed a malar rash, at which point SLE diagnosis was established based on refractory positive ANA, arthritis, malar rash, and seizures.…”

Section: Discussionmentioning

confidence: 99%

SLE initially presenting with neuropsychiatric manifestations and seizure, case report

Khormi

Hijazi

2023

Immunity Inflam & Disease

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder exhibiting variable disease courses and multiple clinical manifestations. SLE's aetiology remains unclear; however, different environmental (e.g., ultraviolet light, infections, drugs, etc.), genetic, and hormonal factors are potentially involved. A positive family history and history of having other autoimmune illnesses are considered high-risk factors for SLE; nevertheless, most SLE cases are scattered. The 2019 European League AgainstRheumatism/American College of Rheumatology classification criteria for SLE include at least one positive antinuclear antibody test as a mandatory entry criterion, followed by additive weighted standards grouped in seven clinical (constitutional, haematological, neuropsychiatric, serosal, musculoskeletal, renal, and mucocutaneous) and three immunological (antiphospholipid antibodies, complement proteins, and SLE-specific antibodies) domains weighted from 2 to 10, with patients accumulating ≥10 points being diagnosed with SLE. Herein, we report a case of neuropsychiatric lupus, a rare and severe form of SLE.

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A Challenging Diagnosis of Systemic Lupus Erythematosus with Status Epilepticus

Abstract: Iftikhar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 4 publications

References 14 publications

A Wolf in Hiding: Epilepsy and Post-ictal Psychosis As Unrecognized Presenting Features of Systemic Lupus Erythematosus

A Wolf in Hiding: Epilepsy and Post-ictal Psychosis As Unrecognized Presenting Features of Systemic Lupus Erythematosus

Seizure as Initial Manifestation of SLE , CASE REPORT

SLE initially presenting with neuropsychiatric manifestations and seizure, case report

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