Psychosis with mania in patient with lupus using corticosteroids, a diagnostic challenge

Abstract

Background: systemic lupus erythematosus is a chronic, autoimmune and multisystemic disease that can present neuropsychiatric manifestations, which represent a diagnostic challenge because it requires to differentiate if they are secondary to the pathology itself or adverse effects of the pharmacotherapeutic treatment. Objective: to establish a differential diagnostic of psychosis on a patient with systemic lupus erythematosus. Clinical case: a 24 year-old female with past medical history of systemic lupus erythematosus, who was admitted to nephrology ward for recurrence of nephrotic syndrome. Prednisone dose was abruptly increased as part of the management given to the patient. After the discharge, the patient presented an episode of psychosis with mania. She was admitted to psychiatry service for a multidisciplinary management with nephrology and rheumatology, and lupic activity was discarded, therefore the patient was treated as a corticosteroid induced psychosis that responded to second generation antipsychotic. Conclusions: it is important for physicians to learn how to distinguish between lupus neuropsychiatric manifestations and those secondary to medical adverse effects in order to make an appropriate clinical approach. DeCS: PSYCHOTIC DISORDERS; ADRENAL CORTEX HORMONES; LUPUS ERYTHEMATOSUS, SYSTEMIC; ADULT; CASE REPORTS.

Keywords

• psicosis
• corticoides
• lupus eritematoso sistémico
• risperidona
• prednisona.