Severe choreoathetosis with neuropsychiartic illness as a rare presentation of systemic lupus erythematosus : A case report and a brief review of literature

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Published Feb 14, 2020
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Vol. 3 No. 01 (2020): International Journal Of Medical Science in Clinical Research and Review

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Dr. Mahendra Wawhal1, Dr. Vajed Mogal2
1Associate Professor-Senior Consultant, MD (Medicine) , Department of Medicine 2Assistant Professor- Consultant Nephrologist, D.M. ( Nephrology) Department of Nephrology M.G.M. Medical College & Hospital, Aurangabad, Maharashtra, India

Abstract

We report a case of severe generalised choreoathetosis associated with psychiatric systemic lupus erythematosus  in a female patient who presented with involuntary movements of hand and footwithout any other manifestation of SLE. The patient was started on aspirin and hydroxychloroquine and her chorea resolved after three weeks of follow up.  This is one of the extremely rare case reports  of Neuropsychiatric systemic lupus erythematosus  (NSLE) where chorea is presented as manifestation of SLE.Neuropsychiatric systemic lupus erythematosus (NPSLE) is the least understood and the most prevalent manifestation of lupus. This review focuses on the pathophysiology, treatment, and new potential therapies for neuropsychiatric manifestations of systemic lupus erythematosus associated with generalised choreoathetosis.


 


Keywords: System lupus erythematosus (SLE), Neuropsychiatric lupus, Chorea.


 

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How to Cite
Dr. Mahendra Wawhal1, Dr. Vajed Mogal2. (2020). Severe choreoathetosis with neuropsychiartic illness as a rare presentation of systemic lupus erythematosus : A case report and a brief review of literature. International Journal of Medical Science in Clinical Research and Review, 3(01), Page : 20–24. Retrieved from http://ijmscrr.in/index.php/ijmscrr/article/view/67

References

    1. M. Postal, L. T. Costallat, and S. Appenzeller, “Neuropsychiatricmanifestations in systemic lupus erythematosus: epidemiology,pathophysiology and management,” CNS Drugs,vol. 25, no. 9, pp. 721–736, 2011.
    2. M. Vadacca, F. Buzzulini, A. Rigon et al., “Neuropsychiatriclupus erythematosus,” Reumatismo, vol. 58, no. 3, pp. 177–186, 2006.
    3. A. M. Walker, D. M. Kaufman, C. R. Pfeffer, and G. E.Solomon, Child and Adolescent Neurology for Psychiatrists,Lippincott Williams & Wilkins, 2008.
    4. Muscal, E.; Brey, R.L.Neurologic manifestations of systemic lupus erythematosus in children and adults. Neurol. Clin., 2010, 28(1), 61-73.
    5. Harel, L.; Sandborg, C.; Lee, T.; von Scheven, E.Neuropsychiatricmanifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies. J. Rheumatol., 2006,33(9), 1873-1877.
    6. Sabbadini, M.; Manfredi, A.; Bozzolo, E.; Ferrario, L.; Rugarli, C.; Scorza, R.; Origgi, L.; Vanoli, M.; Gambini, O.; Vanzulli, L.;Croce, D.; Campana, A.; Messa, C.; Fazio, F.; Tincani, A.; Anzola, G.; Cattaneo, R.; Padovani, A.; Gasparotti, R.; Gerli, R.; Quartesan,R.; Piccirilli, M.; Farsi, A.; Emmi, E.; Passaleva, A.Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations. Lupus, 1999, 8(1), 11-19.
    7. Hanly, J.; Fisk, J.; McCurdy G.; Fougere L.; Douglas J.Neuropsychiatric syndromes in patients with systemic lupuserythematosus and rheumatoid arthritis. J. Rheumatol., 2005, 32(8), 1459-1456.
    8. D’Cruz DP, Khamashta MA, HughesGR – Systemic lupus erythematosus.Lancet 2007; 369: 587-96.
    9. Cervera R, Khamashta MA, Font J, etal. – Morbidity and mortality insystemic lupus erythematosus during a10-year period. A comparison of early and late manifestations in a cohort of1,000 patients. Medicine 2003; 82: 299-308.
    10. Asherson R A. Derkscn R 1I W M. Halrris E N. et al. Chorca. Insystemic lupus crythemattosusaind 'lupus like disealse: aissocialtion with aintiphospholipidaintibodies. Seinin1 ArtlhritisRlieii1987; 16: 253-9.
    11. M.L.Ishimori,B.D.Pressman,D.J.Wallace,andM.H.Weisman, “Posterior reversible encephalopathy syndrome:another manifestation of CNS SLE?”Lupus,vol.16,no.6,pp.436–443, 2007.
    12. J. F. Baizabal-Carvallo, M. Alonso-Juarez, and M. Koslowski,“Chorea in systemic lupus erythematosus,” Journal of ClinicalRheumatology, vol. 17, no. 2, pp. 69–72, 2011.
    13. Hanly, J.; Robichaud, J.; Fisk, J.Anti-NR2 glutamate receptorantibodies and cognitive function in systemic lupus erythematosus. J. Rheumatol., 2006, 33(8), 1553-1558.
    14. Olazarán J.; López-Longo J.; Cruz I.; Bittini A.; Carreño L.Cognitive Dysfunction in Systemic Lupus Erythematosus. Prevalence Correlates Eur. Neurol., 2009, 62(1), 49-55.
    15. Belmont, H.M.; Abramson S.B.; Lie J.T.Pathology and pathogenesis of vascular injury in systemic lupus erythematosus.Interactions of inflammatory cells and activated endothelium. Arthritis Rheum.,1996, 39(1), 9-22.
    16. Garcia Puig J. Gil Aguado A. Barbado J. Garcia Seoane J.Vazquez J J. Manifestacionesneuropsiquicas en el lupuseritematososistdmico. Med Cliii (Barc) 1979; 72: 133-8.
    17. Bouchcz B, Arnott G. Hatron P Y. Choreeet lupus erythemateuxdissemind avec anticoagulant circulant: troiscas. RevNeurol (Paris) 1985; 141: 571-7.
    18. N. M. Orzechowski, A. P. Wolanskyj, J. E. Ahlskog, N. Kumar,and K. G. Moder, “Antiphospholipid antibody-associatedchorea,” Journal of Rheumatology, vol. 35, no. 11, pp. 2165–2170, 2008.
    19. Abbott, N.J.; Mendonca, L.L.; Dolman, D.E.The blood-brain barrier in systemic lupus erythematosus. Lupus, 2003, 12, 908-915.
    20. Nishimura, K.; Harigai, M.; Omori, M.; Sato, E.; Hara, M.Blood-brain barrier damage as a risk factor for corticosteroid-inducedpsychiatric disorders in systemic lupus erythematosus. Psychoneuroendocrinology, 2008, 33(3), 395-403.
    21. Robert M, Sunitha R, ThulaseedharanNK – Neuropsychiatric manifestations systemic lupus erythematosus: a studyfrom South India. Neurol India. 2006; 54: 75 77.
    22. Appenzeller S, Cendes F, CostallatLTL. – Cognitive impairment andemployment status in systemic lupuserythematosus: A perspective longitudinalstudy. Arth& Rheum.2009; 61:680-687.
    23. ung, R.E.; Segall, J.M.; Grazioplene, R.G.; Qualls, C.; Sibbitt, W.LJr.; Roldan, C.A.Cortical thickness and subcortical gray matter reductions in neuropsychiatric systemic lupus erythematosus. PLoSOne, 2010, 5(3), e9302.
    24. Weiner, S.M.; Otte, A.; Schumacher, M.; Klein, R.; Gutfleisch, J.;Brink, I.; Otto, P.; Nitzsche, E.U.; Moser, E.; Peter, H.H.Diagnosis and monitoring of central nervous system involvement in systemiclupus erythematosus: value of F-18 fluorodeoxyglucose PET. Ann. Rheum. Dis., 2000, 59, 377-385.
    25. Navarrete, M.G.; Brey, R.L.Neuropsychiatric systemic lupus erhythematosus. Curr. Treat Opt Neurol., 2000, 2(5), 473-485.
    26. O'Neill, S.G.; Schrieber, L.Immunotherapy of systemic lupus erythematosus. Autoimmun. Rev., 2005, 4, 395-401.
    27. Petri, M.Hydroxychloroquine use in the Baltimore Lupus Cohort:effects on lipids, glucose and thrombosis. Lupus, 1996, 5(Suppl 1), 16-22.
    28. Ntali, S.B.G.; Boumpas, D.T.Cyclophosphamide and Lupus Nephritis: When, how, for how long? Clin. Rev. Allergy Immunol.,2010, [Epub ahead of print].
    29. Austin, H.A 3rd.; Klippel, J.H.; Balow, J.E.; le Riche, N.G.;Steinberg, A.D.; Plotz, P.H.; Decker, J.L.Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N.Engl. J. Med., 1986, 314(10), 614-619.
    30. Strand, V.New therapies for systemic lupus erythematosus.Rheum. Dis. Clin.North Am., 2000, 26(2), 389-407.
    31. Haupt, M.; Millen, S.; Jänner, M.; Falagan, D.; Fischer-Betz, R.; Schneider, M.Improvement of coping abilities in patients withsystemic lupus erythematosus: a prospective study. Ann. Rheum. Dis., 2005, 64, 1618-1623.
    32. G. K. Bertsias, J. P. A. Ioannidis, M. Aringer et al., “EULAR recommendationsfor the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a taskforce of the EULAR standing committee for clinical affairs,”Annals of the Rheumatic Diseases, vol. 69, no. 12, pp. 2074–2082, 2010.