Intractable Progressive Cerebral Infarction with Multiple Atypical Aneurysms in Systemic Lupus Erythematosus

We report a case of intractable progressive cerebral infarction with multiple fusiform aneurysms in a 34-year-old female patient with systemic lupus erythematosus (SLE), non-responsive to massive immunotherapy. The patient visited the emergency department with dysarthria and left-sided hemiparesis that occurred 2 days before. She was diagnosed with SLE involving the brain and received 12 cycles of cyclophosphamide 12 years prior. Brain diffusion-weighted imaging showed acute infarctions involving the pons and medulla. Additionally, multifocal microbleeding-like signals in various cisternal spaces were detected using susceptibility-weighted imaging. Digital subtraction angiography revealed multiple fusiform aneurysms. Despite antithrombotic treatment with trif lusal and immunotherapies, including corticosteroids, mycophenolate mofetil, and immunoglobulins, for cerebral vasculitis associated infarction, her neurologic deficits worsened with recurrent cerebral infarction. Further investigation for accurate diagnosis and treatment is required.

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Acute meningoencephalitis in a patient with systemic lupus erythematosus

Vojnosanitetski pregled ◽

10.2298/vsp1307690p ◽

2013 ◽

Vol 70 (7) ◽

pp. 688-692 ◽

Cited By ~ 1

Author(s):

Aleksandra Peric-Popadic ◽

Mirjana Bogic ◽

Vesna Tomic-Spiric ◽

Vojislav Djuric ◽

Jasna Bolpacic ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Central Nervous System ◽

Lupus Erythematosus ◽

Accurate Diagnosis ◽

Careful Examination ◽

Central Nervous System Infections ◽

Systemic Lupus ◽

Proliferative Lupus Nephritis ◽

Causes Of Mortality ◽

The Brain

Introduction. Infections in patients with systemic lupus erythematosus (SLE) are a significant factor of morbidity and mortality. Although central nervous system infections, including septic meningitis, are rare in patients with SLE, they can be significant causes of mortality inspite of the prompt and accurate diagnosis and proper management. Case report. We presented a woman with the diagnosis of SLE and diffuse proliferative lupus nephritis. Because of disease activity we introduced cytostatic immunosuppressive therapy, cyclophosphamide and then azathioprine. Meningoencephalitis, staphylococcal sepsis and abscess of the brain, with resulting seizures developed. Conclusion. This case alerts to the need of careful examination of patients with SLE, collection of adequate cultures and evaluation of predisposition towards ifnections, before the introduction of immunosuppressants due to potentially fatal infection.

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MR Manifestations of the Brain in Neuropsychiatric Systemic Lupus Erythematosus Patients

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2008.58.1.1 ◽

2008 ◽

Vol 58 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Kyu Chan Oh ◽

Woo Mok Byun ◽

Han Won Jang ◽

Kum Rae Kim

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Neuropsychiatric Systemic Lupus Erythematosus ◽

The Brain

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A Case of Thrombotic Thrombocytopenia Purpura Associated with Systemic Lupus Erythematosus: Diagnostic Utility of ADAMTS-13 Activity

Autoimmune Diseases ◽

10.4061/2011/483642 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Risa Yamada ◽

Kazuhisa Nozawa ◽

Takashi Yoshimine ◽

Yoshinari Takasaki ◽

Hideoki Ogawa ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Thrombotic Microangiopathy ◽

Autoimmune Disorder ◽

Accurate Diagnosis ◽

Diagnostic Utility ◽

Systemic Lupus

Thrombotic thrombocytopenia purpura (TTP) caused by a deficiency in ADAMTS-13 activity is considered to involve a subset of thrombotic microangiopathy (TMA). Although concept of TTP is included under the umbrella of TMA, discrimination of TTP from TMA is occasionally difficult in an autoimmune disorder. Herein, we report a case with TTP associated with systemic lupus erythematosus (SLE). In this case, it was difficult to discriminate TTP from TMA and the measurement of ADAMTS-13 activity was useful for obtaining an accurate diagnosis. SLE patients having thrombocytopenia in complication with anemia should be considered a monitoring of ADAMTS-13 activity even though the patients lacked symptoms of TTP related to the microvascular coagulation.

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Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus

Lupus ◽

10.1177/0961203318815583 ◽

2018 ◽

Vol 28 (1) ◽

pp. 133-136 ◽

Cited By ~ 3

Author(s):

H. Furuya ◽

K. Ikeda ◽

K. Iida ◽

K. Suzuki ◽

S. Furuta ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Case Reports ◽

Toxoplasmic Encephalitis ◽

Systemic Lupus ◽

Atypical Symptoms ◽

Hematopoietic Transplantation ◽

Isolated Lung ◽

The Brain ◽

Common Parasite

Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease.

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