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Neuropsychiatric lupus with posterior reversible encephalopathy syndrome: a rare presentation
  1. Ramiz Islam1,
  2. Sayonee Das1,
  3. Sidhartha Chattopadhyay2 and
  4. Sagar Basu2
  1. 1Internal Medicine, KPC Medical College and Hospital, Jadavpur, West Bengal, India
  2. 2Neurology, KPC Medical College and Hospital, Jadavpur, West Bengal, India
  1. Correspondence to Dr Sagar Basu; drsagar.basu{at}gmail.com

Abstract

Systemic lupus erythematosus presenting with neuropsychiatric symptoms (NPSLE) along with posterior reversible encephalopathy syndrome (PRES) is rare. A young woman of 29 years presented with various neuropsychiatric symptoms along with low-grade fever, occasional headache, skin rash, arthralgias and gradually became non-ambulatory over last 6 months. After admission, she had an episode of generalised tonic-clonic seizure, followed by drowsiness. She was normotensive. Investigations revealed no evidence of any underlying infection, normal renal functions and electrolytes; but other parameters were supportive to a diagnosis of NPSLE. MRI brain showed vasogenic oedema characterised by symmetrical hyperintensities over posterior brain regions in T2 and fluid attenuated inversion recovery images with no restricted diffusion in diffusion weighted image suggestive of PRES. A diagnosis of NPSLE presenting with PRES, particularly in the absence of hypertension and abnormal renal functions was made, which is a rare presentation. She responded well to immunomodulatory therapy with methylprednisolone and monthly cyclophosphamide.

  • epilepsy and seizures
  • neuroimaging
  • muscle disease
  • systemic lupus erythematosus

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Footnotes

  • Twitter @SidharthaChat14

  • Contributors RI and SD clinically assessed the case and initiated manuscript writing. SC critically reviewed the manuscript and search for references. SB finally reviewed the manuscript along with references and other points for final submission. All authors have reviewed the manuscript for intellectual contents and approved for final version. All of them are accountable for all aspects of the work in terms of accuracy and integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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