An Interesting Case Series of Neuropsychiatric Lupus: A Combination of Inflammatory and Thrombotic Origin

Abstract

Systemic Lupus Erythematosus (SLE) is a versatile autoimmune disorder with multisystem organ involvement, most commonly involving the skin, joints, vasculature, and associated immunological abnormalities. The hallmark of SLE is the presence of circulating non organ specific humoral autoantibodies synthesised by so-called T cell-dependent B cells, which are germline encoded. Patients with SLE can exhibit symptoms of Central Nervous System (CNS) involvement, termed CNS Lupus, which may also have associated psychiatric manifestations, where the entity gets the designation of Neuropsychiatric SLE (NPSLE). CNS Lupus is often a diagnosis of exclusion, as there are many other aetiological factors that could result in seizures and encephalitis picture. A detailed examination of patients presenting with isolated late-onset seizures is very helpful in uncovering Connective Tissue Disorder (CTD) as the cause of seizures. The manifestations of NPSLE (19 Neuropsychiatric syndromes) can be focal and diffuse, ranging from non specific symptoms such as headache and cognitive impairment to severe manifestations such as memory loss, seizures, stroke, and suicidal intentions. Neuropsychiatric symptoms often occur during the first year of SLE but can rarely also be the presenting symptom of the disease. Antiphospholipid antibodies (Anticardiolipin, Lupus anticoagulant, Anti β2 glycoprotein) and Anti Ribosomal P antibodies are among the frequently associated antibodies in NPSLE, which, in turn, increase the risk of both focal and diffuse neurological complications. A single episode of abortion or miscarriage is a vital clue for a detailed work-up of female patients for the possibility of an underlying occult potential of CNS Lupus in the absence of seizures. The present case series focuses on five female patients who presented with NP symptoms, and finally, the cause was attributed to the involvement of CNS in SLE after excluding other possible organic causes.

Keywords

• antiphospholipid antibody
• central nervous system lupus
• cognitive dysfunction
• lupus fog
• seizures