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Guillain-Barré syndrome (GBS) is an important cause of acute neuromuscular paralysis. 1 Specific management of GBS consists of immunomodulation which includes plasmapheresis, intravenous immunoglobulin (IVIg), and/or steroids. Ventilatory care is important in severely affected individuals. Respiratory failure requiring mechanical ventilation remains one of the most serious implications and occurs in approximately 30% of cases. 2 Morbidity and mortality are more frequent in severely affected patients, and prognosis tends to improve with wider availability of specialized intensive care unit (ICU) management and adequate techniques for airway protection and ventilation. 3 The overall cost of management of GBS is very high especially in a developing country like India. This leads to out-of-pocket expenditure (OOPE) in terms of health care for majority of our patients in the absence of health insurance causing grave financial suffering.Catastrophic health expenditure (CHE) refers to health expenditure exceeding 10% of total monthly consumption expenditure or more than 40% of the non-food consumption expenditure. 4 This single parameter can be used to assess the financial impact as well as lack of preparedness of population studied to face the challenge of an acute or chronic illness. Neurological illness is especially prone to create financial challenges including impoverishment of households due to the cost of treatment, loss of employment and dependence on other members for activities of daily living. This study was conducted with the objective of assessing the socio-economic aspect of an acute disabling neurological illness like GBS in a country like India where there are still deficiencies in the equitable distribution of health care and resources.

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BackgroundSystemic lupus erythematosus (SLE) is the prototypic autoimmune connective tissue disorder (CTD) usually affecting young females. Central nervous system lupus is a serious complication encountered in SLE cases. Predominant involvement of rhombencephalon in patients of SLE at the first contact with health care professional has not been seen and described frequently in the literature. It still remains a diagnostic and therapeutic challenge.Case presentationThis paper describes a case of SLE in an adolescent female who was diagnosed as having rhombencephalitis, which is a rare presentation of SLE.ConclusionsCentral nervous system lupus should be included in the provisional diagnosis of any young female patient presenting with complicated neurologic manifestations over the background of joint pain or fever or headache or confusion or psychosis, to avoid misdiagnosis and aid in timely institution of aggressive immunotherapy.

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