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Background Neuropsychiatric manifestations are frequently reported in systemic lupus erythematosus (SLE) patients. This study was done to describe electroencephalographic (EEG) findings in SLE patients with neuropsychiatric manifestation (NPSLE). Results Among 60 SLE patients, there were 50 females (83.3%) and 10 males (16.7%). EEG abnormalities were reported in 12 patients out of 30 (40%) with NPSLE, while all patients with non-NPSLE (n = 30) had no EEG abnormalities; diffuse slowing (20%) was the most common abnormalities, followed by generalized epileptiform activity (13.3%), and lastly temporal epileptiform activity (6.7%). Seizure was the most reported neuropsychiatric disorder in 13 patients (43.3%); 8 of them had abnormal EEG (61.5%). Periventricular white matter lesion (23.3%) followed by infarction (13.3%) were the most common MRI brain findings among 53.3% of NPSLE group. Half of the cases with EEG abnormality had normal brain MRI. SLEDAI score and ACL IgM positivity were higher in the NPSLE group than the non-NPSLE group. EEG is not a sensitive or specific test for detecting NPSLE with sensitivity (37.5%) and specificity (57.1%). Conclusion Not all patients with NPSLE must have abnormal brain MRI or EEG. EEG is a useful assistant tool in the assessment of different manifestations of NPSLE, but it cannot be used as a screening test alone and must be supplemented by neuroimaging studies.

Secretory villous adenoma is one of the rare causes of severe secretory diarrhea, acute kidney injury and refractory electrolyte imbalance is the classic triad of this disorder named McKittrick-Wheelock syndrome. Aggressive hydroelectrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopic resection or surgery. High clinical suspicion in patients with severe dehydration due to secretory diarrhea and concomitant electrolyte imbalance is both mandatory and essential for early diagnosis and treatment before complications arise. In this case we describe a female patient suffering from 6 months of secretory diarrhea, presented to our emergency department with severe dehydration, acute renal failure, hyponatremia and hypokalemia. After rehydration and electrolyte replacement, confirmation of the diagnosis was done by colonoscopy and biopsy showing 3 sessile colonic polyps (2 at distal end of Transverse colon, largest one at descending colon) the biopsy confirmed the presence of villous adenoma with high grade dysplasia. Normalization of the electrolyte imbalance and the kidney functions was done and she was successfully treated with surgical resection that lead to complete resolution of sympt oms. McKittrick-Wheelock syndrome is a rare life threatening depletion syndrome that can lead to acute kidney injury and electrolyte imbalance with concomitant organ damage. Early management by vigorous repletion therapy and curative surgical resection will mostly resolve the symptoms and complications.

Background: Secretory villous adenoma is one of the rare causes of severe secretory diarrhea, acute kidney injury and refractory electrolyte imbalance is the classic triad of this disorder named McKittrick-Wheelock syndrome. Aggressive hydro electrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopic resection or surgery. High clinical suspicion in patients with severe dehydration due secretory diarrhea and concomitant electrolyte imbalance is both mandatory and essential for early diagnosis and treatment before complications arise.

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