Neuropsychiatric Manifestations of Systemic Lupus Erythematosus - A Case Report

Abstract

Systemic lupus erythematosus (SLE) is known for marked heterogeneity of clinical manifestations and pathogenesis with the potential of affecting virtually every organ system. Neuropsychiatric manifestations of systemic lupus erythematosus are difficult to recognize and treat as they remain one of the least understood complications of this disease. Our case describes a 42-year-old female who presented to the emergency department with proximal weakness of the left lower extremity, magnetic resonance imaging (MRI) of the brain revealed a small infarct in the medial left temporal lobe. Workup was remarkable for elevated inflammatory markers. The patient was discharged on appropriate medical therapy however returned to the emergency department one month later after a witnessed focal seizure. Neuroimaging was consistent with cerebral vasculitis and autoimmune workup revealed a diagnosis of SLE. Our case highlights the importance of recognizing that neuropsychiatric manifestations of SLE often occur in absence of other systemic manifestations and can be the initial presentation of SLE. Maintaining a high clinical suspicion for Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) could afford the ability to halt disease progression in the earliest of phases and thus improve quality of life through early administration of appropriate pharmacotherapy.