The Complexities of Neuropsychiatric Lupus: Pathogenesis, Diagnosis, and Management

Ramesh T V¹, Gopi Ayyaswamy², Zioni Sangeetha³, Vinod Kumar P ⁴*

This case determines the critical need for early diagnosis and aggressive treatment of CNS vasculitis in SLE to achieve remission.

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with widespread systemic involvement, including neurological manifestations that affect 10 to 80% of patients. Neurological symptoms in SLE can be diverse, ranging from headaches to severe conditions like CNS vasculitis. Methodology: We present a case of a 32-year-old female with a two-year history of SLE who had been non-compliant with her treatment for six months. She presented with new-onset symptoms, including low-grade fever, persistent headache, significant weight loss, tinnitus with hearing loss, and polyarthralgia. Laboratory tests and MRI were used for diagnosis. Results: Laboratory findings revealed elevated anti-dsDNA antibodies, decreased complement levels (C3 and C4), and increased serum Lactate Dehydrogenase (LDH). MRI of the brain showed diffuse T2 FLAIR hyperintensities, indicative of CNS vasculitis. The patient was diagnosed with CNS vasculitis secondary to SLE. Conclusion: The patient was treated with Mycophenolate Mofetil 500 mg twice daily, Hydroxychloroquine 200 mg nightly, and Methylprednisolone 8 mg daily. Significant improvement and resolution of symptoms were achieved within two weeks. This case highlights the importance of early diagnosis and aggressive treatment in managing SLE-related CNS vasculitis, emphasizing the need for adherence to treatment and regular follow-up to prevent disease progression.

Keywords: SLE, CNS vasculitis, anti-dsDNA, Mycophenolate Mofetil, Hydroxychloroquine, Methylprednisolone

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