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- Title
ACUTE PSYCHOSIS AS THE FIRST MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS.
- Authors
Freitas, Raquel; Cunha, Maria Margarida; Godinho, Fátima; da Silva, José António Canas; Sousa, Sandra
- Abstract
Background: Neuropsychiatric manifestations in systemic lupus erythematosus (SLE) can be severe and heavily impact quality of life and disease outcome. Headaches, mood disorders, cognitive dysfunction, seizures and cerebrovascular disease are the most common in patients with SLE and can occur in up to 50% of patients; however, psychosis per se is bit uncommon (less than 5%). Psychosis may be due to drugs (steroids) used for SLE or secondary to the disease itself. Objectives and Methods: We report the case of a 37-year-old female patient who presented with acute psychosis as the initial manifestation of systemic lupus erythematosus. Results: A 37-year old female patient was admitted to the emergency department because of a suicide attempt. She complained of peripheral inflammatory polyarthralgias that appeared about 3 months before with vasculopathy lesions in the hands 5 days before. On admission she was with severe auditory and visual hallucinations associated with paranoid delusions. There was no evidence of arthritis and no neurological deficits. Low degree fever and very discrete vasculopathy cutaneous lesions on the hands were noted by a rheumatologist. Increased inflammatory parameters (sedimentation rate 62 mm in the 1st hour and reactive C protein 5 mg/dL) and hypocomplementemia (C3 54 mg/dL; C4 7,9 mg/dL) was observed. She did a cerebral magnetic resonance and a lumbar puncture without alterations. The echocardiogram showed a light pericardial effusion. She started antipsychotic drugs without improvement. Autoimmunity was positive for ANA (>1/640), anti dsDNA, SSA, Ro52 and ribosomal P protein. She was diagnosed with systemic lupus erythematosus and started methylprednisolone pulses and cyclophosfamide 1000 mg EV Two weeks after the first cyclophosfamide infusion she showed impressive psychiatric symptoms improvement and a more coherent speech, and two months after she returned to her normal day-to-day life. Conclusion: SLE is a chronic autoimmune disorder with occasional central nervous system involvement. Psychosis due to lupus is an uncommon event that usually occurs early in the course of the disease. Physicians must be alert because psychosis may be the first manifestation of SLE and immunosuppressive therapy is required in most cases.
- Subjects
SYSTEMIC lupus erythematosus treatment; PSYCHOSES; NEUROBEHAVIORAL disorders; QUALITY of life; DISEASE progression; IMMUNOSUPPRESSIVE agents
- Publication
Acta Reumatológica Portuguesa, 2019, p153
- ISSN
0303-464X
- Publication type
Case Study