Neuropsychiatric impairment in a patient with systemic lupus erythematosus: a case report (Atena Editora)

Abstract

Patient A.S.D.A., 59 years old, female, with a previous diagnosis of Systemic Lupus Erythematosus (SLE), hypertension and hypothyroidism, all under regular drug treatment. Admitted to the Santa Casa de Misericórdia de São Carlos in June 2022 with a complaint of mental confusion and fever. Laboratory and imaging tests showed no changes, except for the cerebrospinal fluid, which suggested an inflammatory process. Unable to rule out meningoencephalitis, empirical antibiotic therapy was started with Ceftriaxone for 7 days and, after completion, pulse therapy with methylprednisolone and cyclophosphamide was performed due to evidence of clear activity of renal disease. She was discharged asymptomatic. She returned to the service after 16 days, with worsening neurological status, when, then, the hypothesis of neurolupus was raised. Imaging confirmed changes in white matter secondary to vasculitis. Thus, a new pulse therapy was performed and, due to the absence of clinical improvement, human immunoglobulin was started as a therapeutic test. Remained in Glasgow 7, evolving with decerebrate. As a result of the refractoriness of all treatments instituted, agreed with the family, palliative care. The report in question is a Catastrophic Neurolupus, a rare case, with severe evolution and unfavorable prognosis.