Reversible Bilateral Basal Ganglia and Brainstem Lesions in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report

Authors

  • Rocksy Fransisca V Situmeang Department of Neurology, Siloam Hospitals Lippo Village
  • Reza Stevano Faculty of Medicine, Pelita Harapan University
  • Ekawaty Yasinta Yohana Larope Department of Pediatrics, Siloam Hospitals Lippo Village
  • Ratna Sutanto Department of Radiology, Siloam Hospitals Lippo Village

DOI:

https://doi.org/10.19166/med.v9i3.6976

Keywords:

Systemic lupus erythematosus, Neuropsychiatric lupus, Immunoglobulin therapy, Case report

Abstract

The pathophysiology behind neuropsychiatric SLE (NPSLE) remains poorly understood and its clinical and radiological manifestations are highly varied. In this report, we present a complex case of an adolescent female patient with a three-week history of systemic symptoms (fever, nausea, vomiting, weight-loss, polyarticular joint pain), progressive motor weakness, tremor, and altered mental status. Physical examination was significant for oromandibular and cervical dystonia rigidity, and general weakness with imposed right-sided hemiparesis. A head MRI demonstrated bilateral hyperintense lesions of the basal ganglia and brainstem, SS without restricted diffusion. The patient was diagnosed with NPSLE, lupus nephritis, electrolyte imbalance, severe hypoalbuminemia, lupus cardiomyopathy, autoimmune hemolytic anemia, pulmonary tuberculosis, and sepsis. The patient was given treatment in the ICU with pulse dose corticosteroids, intravenous antibiotics, intravenous immunoglobulins (IVIg), and supportive treatment with correction of hematologic and electrolyte abnormalities. Her condition improved rapidly. Full alertness was regained, and symptoms of oromandibular dystonia, tremor, and weakness diminished significantly. A follow-up MRI three weeks later revealed complete disappearance of lesions, which we attribute to resolution of the inflammatory process in the brain.

References

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Published

2023-06-04

Issue

Vol. 11 No. 2 (2022): February

Section

Case Report

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