Systemic Lupus Erythematosus Presenting as Subacute Delirium in an 82‐Year‐Old Woman

Heckman, George A.; Παπαϊωάννου, Αλεξάνδρα; Adachi, Jonathan D.; Denburg, Judah A.

doi:10.1046/j.1532-5415.2001.49093.x

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Although they predominated in our study, the exclusive responsibility of SLE is exceptional in most studies. In the paediatric series, the prevalence of this syndrome was 35%, also it can be found at elderly patients [17] [18] [19].…”

Section: Discussionmentioning

confidence: 99%

Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience

Kane¹,

Dieng²,

Fall³

et al. 2019

OJRA

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Introduction: The central, psychiatric and peripheral neurological manifestations of lupus are among the most severe visceral disorders and are grouped under the general term of "neuro-psychiatric systemic lupus erythematosus" (NPSLE). We conducted a cross-sectional observational study within our Department of Internal Medicine aimed at describing the clinical and evolutionary aspects of central neurological disorders of SLE, excluding lupus myelopathy. Patients and Methods: This was a retrospective and observational cross-sectional study carried out from Hospital in Dakar (Senegal). All patients hospitalized during this period who met the 1997 ACR classification criteria of SLE and who presented with a central neuropsychiatric syndrome attributable to SLE (as defined by ACR 1999) were included. Patients with isolated headache, acute myelitis or secondary neurological involvement attributable to a toxic, metabolic, infectious or tumour-related cause were excluded from our study. Results: During the study period, 10 patients with neuropsychiatric lupus involvement were treated at our institution, including 9 women and 1 man; the median age was 29 years (20 -55 years). Neurological involvement occurred during the course of lupus evolution in 9/10 cases. The median time to SLE evolution was 18 months (0 -60 months). Neuropsychiatric syndromes as defined by the 1999 ACR were commonly associated and more than half of our patients had multiple neuropsychiatric syndromes. There were 5 cases of confusion syndrome and coma, 4 cases of seizure, 3 cases of psychosis, 2 cases of acute cerebrovascular disease and 1 case of aseptic meningitis. Among the extra-neurological manifestations of SLE, haematological and dermatological involvements were common. Renal involvement affected half of the patients. The other manifestations were: polyarthritis in 3 patients, se-How to cite this paper: Kane, B.S., Dieng, M., Fall, B.C., Sow, M., Ndao, A.C., Djiba, B., Niasse, M., Diagne, N., Faye, A., Ndongo, S. and Pouye, A. (2019) Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience. Open Journal of Rheumatology and Autoimmune Diseases,9,[25][26][27][28][29][30][31][32][33][34]

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Section: Discussionmentioning

confidence: 99%

Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience

Kane¹,

Dieng²,

Fall³

et al. 2019

OJRA

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“…Some do mention seizures and psychosis (components of the 1982 and 1997 ACR classification criteria of SLE) as a common manifestation of NPSLE in the older patients [9,10,30,31,35,97]. Nevertheless, case reports and series reveal additional NPSLE manifestations including cognitive impairment, movement disorders, cranial neuropathy, CVD, myelitis, acute confusional state, depression and peripheral neuropathy [9,89,[98][99][100] responsive to corticosteroid and/ or immunosuppressive therapy. Thus, any neuropsychiatric manifestation in a context of other systemic symptoms or signs suggestive of SLE should be investigated.…”

Section: Clinical Manifestations Of Late-onset Npslementioning

confidence: 99%

“…Frequency of ANA positivity is increased in the older healthy population as well [117], and a threshold of ANA titres > 1:160 was suggested in the older age group instead of the classical threshold titre of > 1:80 [12]. Studies on the serologic pattern in late-onset NPSLE are absent; however, case reports do emphasise positive anti-dsDNA antibodies with low serum complements in the vast majority of cases [89,[98][99][100].…”

Section: Serological Manifestations Of Late-onset Npslementioning

confidence: 99%

“…Medications for patients with late-onset SLE do not differ in most studies; however, some observational studies report lower use of cyclophosphamide and others report lower doses of glucocorticoids and of cyclophosphamide [9,29,35]. Direct information on the treatment of NPSLE in lateonset SLE is lacking, except for several case reports that used lower doses of glucocorticoids, sometimes as a sole treatment without the addition of immunosuppressants [89,[98][99][100].…”

Section: Management Of Late-onset Npslementioning

confidence: 99%

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Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

2021

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Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease with variable clinical manifestations. Neuropsychiatric systemic lupus erythematosus (NPSLE) includes the neurologic syndromes of the central, peripheral and autonomic nervous system and the psychiatric syndromes observed in patients with SLE. Neuropsychiatric systemic lupus erythematosus events may present as an initial manifestation of SLE or may be diagnosed later in the course of the disease. Older adults with NPLSE include those who are ageing with known SLE and those with late-onset SLE. The diagnosis of NPSLE across the lifespan continues to be hampered by the lack of sensitive and specific laboratory and imaging biomarkers. In this review, we discuss the particular complexity of NPSLE diagnosis and management in older adults. We first discuss the epidemiology of late-onset NPSLE, then review principles of diagnosis of NPSLE, highlighting issues that are pertinent to older adults and that make diagnosis and attribution more challenging, such as atypical disease presentation, higher medical comorbidity, and differences in neuroimaging and autoantibody investigations. We also discuss clinical issues that are of particular relevance to older adults that have a high degree of overlap with SLE, including drug-induced lupus, cerebrovascular disease and neurocognitive disorders. Finally, we review the management of NPSLE, mainly moderate to high-dose glucocorticoids and immunosuppressants, again highlighting considerations for older adults, such as increased medication (especially glucocorticoids) adverse effects, ageing-related pharmacokinetic changes that can affect SLE medication management, medication dosing and attention to medical comorbidities affecting brain health.

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Cognitive decline in an old woman: Do not miss a rare etiology!

Compté

Breucker

Decaux

et al. 2012

Experimental Gerontology

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Systemic Lupus Erythematosus Presenting as Subacute Delirium in an 82‐Year‐Old Woman

Abstract: Neuropsychiatric symptoms can be prominent in older people, presenting features of SLE. This case illustrates the lowest dose of corticosteroids shown to be effective in an older patient with delirium due to SLE.

Cited by 6 publications

References 31 publications

Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience

Neurological Involvement in Systemic Lupus Erythematosus (SLE): Our Recent Experience

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

Cognitive decline in an old woman: Do not miss a rare etiology!

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