Case Report: Psychopathological Syndromes in the Course of Lupus Erythematosus and the Co-occurrence of Lupus Erythematous With Mental Disorders

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to a chronic inflammatory process in tissues and organs. The neuropsychiatric systemic lupus erythematosus (NPSLE) is a set of neuropsychiatric symptoms that derive from the central and peripheral nervous system and are observed in the course of SLE.Case Report and Final Diagnostic and Therapeutic Results: A diagnostic and therapeutic process in a patient with the signs and symptoms of SLE and bipolar disorder (BD) has been described. Bipolar disorder has been diagnosed as a primary disorder while SLE as a comorbid disease.Discussion: Common immunological mechanisms in BD and SLE are the reason for difficulties in diagnosing BD with co-occurring SLE. It should be determined whether BD is a primary disorder or a secondary component of a clinical picture of SLE (NPSLE) or whether mood and/or psychotic disorders are the result of steroid therapy in the course of SLE (steroid-induced mood and psychotic disorders, SIMPD).Conclusion and the Patient's Perspective: The presented case report is a unique description of a patient with a primary diagnosis of BD with comorbid SLE.

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Acute hypomania in systemic lupus erythematosus, differential diagnosis. A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1414 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S393-S393 ◽

Cited By ~ 1

Author(s):

D.K. Ochoa García ◽

G.M. Chauca Chauca ◽

L. Carrión Expósito

Keyword(s):

Systemic Lupus Erythematosus ◽

Bipolar Disorder ◽

Differential Diagnosis ◽

Case Report ◽

Lupus Erythematosus ◽

Depressive Episode ◽

Psychiatric Symptoms ◽

Brain Mri ◽

Systemic Lupus ◽

Neuropsychiatric Sle

IntroductionIt is well known that seizures and psychosis are diagnostic criteria for systemic lupus erythematosus (SLE), however, there could be many other neuropsychiatric symptoms. The American College of Rheumatology Nomenclature provides case definitions for 19 neuropsychiatric syndromes seen in SLE (NPSLE), including cognitive impairment, psychosis, mood and anxiety disorders. Lack of specific manifestations difficult diagnosis and treatment.ObjectivesTo address the diagnostic difficulties that involve the appearance of hypomanic symptoms in the course of SLE treated with high doses of corticoids in a patient with a depressive episode history.MethodDescription of case report and literature revision. We report the case of a 22-year-old woman who presented irritable mood, sexual disinhibition, insomnia and inflated self-esteem. The patient was recently diagnosed with SLE and was on treatment with 50 mg/d prednisone. She had familiar history for bipolar disorder and was taking 20 mg/d paroxetine since the last 6 months after being diagnosed with major depressive episode.ResultsWe proposed differential diagnosis between psychiatric symptoms secondary to central nervous system SLE involvement, a comorbid bipolar disorder or prednisone-induced mood symptoms. Fluctuation of hypomanic symptoms during hospitalization, poor relationship with variation in corticosteroid doses, findings on brain MRI compatible with vasculitis and positive antibodies, oriented this case to a neuropsychiatric manifestation of LES.ConclusionsWe should keep in mind that symptoms of neuropsychiatric SLE may vary from more established manifestations of NPSLE to mild diffuses ones. More studies are needed to expand knowledge in the relationship between mood disorders and neuropsychiatric SLE.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2039-2 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

José Sordia-Ramírez ◽

Adrián Infante-Valenzuela ◽

Iván de Jesús Hernández-Galarza ◽

Antonio Costilla-Esquivel

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Systemic Lupus

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Lupus Cerebritis Refractory to Guideline-Directed Therapy: A Case Report

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211008708 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110087

Author(s):

Suman Rao ◽

Akhila Sunkara ◽

Ashwini Ashwath ◽

Nimisha Srivastava ◽

Emily Albert

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Antipsychotic Agent ◽

Systemic Lupus ◽

Drug Induced ◽

Multiple Organs ◽

Organ Systems ◽

Current Guidelines

Systemic lupus erythematosus is an autoimmune disease that affects multiple organs and organ systems, subsequently requiring an elaborate regimen for management. We present the case of a 63-year-old female who developed unrelenting symptoms of drug-induced lupus, which persisted even after the offending agent was withdrawn, unmasking her underlying systemic lupus erythematosus. She continued to develop neuropsychiatric symptoms, including mania and hallucinations, which complicated the management of her disease. After exhausting the bank of anti-inflammatory and immunomodulators recommended by current guidelines, we found that a combination of rituximab infusions with thiothixene, an antipsychotic agent, significantly improved our patient’s neuropsychiatric symptoms. Further research should be conducted to determine the efficacy of rituximab in the treatment of resistant lupus cerebritis, and to validate the use of thiothixene in the management of neuropsychiatric symptoms secondary to lupus.

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Neuropsychiatric Symptoms as the first Manifestation of Systemic Lupus Erythematosus in a Male - A Case Report

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v8i10.28 ◽

2020 ◽

Vol 08 (10) ◽

Author(s):

Dr Rakesh Mohanty ◽

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Systemic Lupus

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AYURVEDIC MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj3809122021 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3158-3162

Author(s):

Vatsal Dhudashiya ◽

Radhikaba Zala ◽

Pooja B.A ◽

Sangamitra Pattnaik

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Connective Tissue ◽

Female Patient ◽

Lupus Erythematosus ◽

Morning Stiffness ◽

Signs And Symptoms ◽

Early Morning ◽

Common Symptom ◽

Systemic Lupus

Systemic Lupus Erythematosus is a systemic autoimmune connective tissue disease. Arthralgia is a common symptom, occurring in 90% of patients, and is often associated with early morning stiffness. Considering symp- tomatology, In Ayurveda classics, it can be compared with amavata1. This is the case report of a female patient aged 19 years suffering from multiple joints pain associated with swelling and tenderness and finger deformities, Diagnosed as Systemic lupus erythematosus (SLE). Visited the Department of Panchakarma, SAMC&H, Banga- lore for the treatment. Virechana karma followed by Shamana Aushadhi was administered. Significant improve- ment in the signs and symptoms was observed clinically. Keywords: Systemic Lupus Erythematosus, SLE, Amavata, Virechana, Shamana Auaushadhi

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Exacerbations of bipolar disorder triggered by chloroquine in systemic lupus erythematosus—a case report

Lupus ◽

10.1177/0961203313513818 ◽

2013 ◽

Vol 23 (2) ◽

pp. 188-193 ◽

Cited By ~ 14

Author(s):

J Bogaczewicz ◽

T Sobów ◽

A Bogaczewicz ◽

E Robak ◽

P Bienkowski ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Bipolar Disorder ◽

Case Report ◽

Lupus Erythematosus ◽

Systemic Lupus

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Wernicke’s encephalopathy mimicking neuropsychiatric symptoms in patients with systemic lupus erythematosus: a report of three cases and literature review

Lupus ◽

10.1177/0961203316658556 ◽

2016 ◽

Vol 26 (2) ◽

pp. 195-199 ◽

Cited By ~ 2

Author(s):

S Appenzeller ◽

F Reis ◽

L T Lavras Costallat ◽

J Adams Pérez ◽

C F Saldanha ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Thiamine Deficiency ◽

Clinical Investigation ◽

Neuropsychiatric Symptoms ◽

Signs And Symptoms ◽

Chronic Inflammatory Disease ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

Systemic Lupus

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves many organs and systems. Nervous system involvement in SLE encompasses neurological and psychiatric disorders, and remains a diagnostic and therapeutic challenge. Wernicke’s encephalopathy (WE) is a neurological disorder that occurs as a consequence of thiamine deficiency, and its clinical presentation resembles the neuropsychiatric events attributed to SLE (NPSLE). Differentiation between these two entities is crucial because their treatment differs greatly and can change prognosis. We describe three cases of patients with SLE who presented with initial clinical findings suggestive of NPSLE that, at the end of a thorough clinical investigation, were actually found to represent WE. In all of these cases, treatment with thiamine resulted in significant improvement. WE should be considered as a differential diagnosis in SLE patients with neuropsychiatric signs and symptoms, especially when risk factors for thiamine deficiency are present.

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