Patients with systemic lupus erythematosus (SLE) experience neuropsychiatric symptoms. The term neuropsychiatric SLE (NPSLE) is a generic term that refers to a series of neurological and psychiatric symptoms directly related to SLE. In approximately 30% of patients with neuropsychiatric symptoms, SLE is the primary cause (NPSLE), and symptoms manifest more frequently around SLE onset. Neurovascular and psychotic conditions can also lead to NPSLE. Pathogenesis of NPSLE is implicated in both neuroinflammatory and ischemic mechanisms, and it is associated with high morbidity and mortality. After diagnosing and assigning causality, NPSLE treatment is individualized according to the type of neuropsychiatric manifestations, type of the predominant pathway, activity of SLE, and severity of the clinical manifestations. There are many problems to be addressed with regards to the diagnosis and management of NPSLE. Controlled clinical trials provide limited guidance for management, and observational cohort studies support symptomatic, antithrombotic, and immunosuppressive agents. The purpose of this review was to provide a detailed and critical review of the literature on the pathophysiology, diagnosis, and treatment of NPSLE. This study aimed to identify the shortcoming in diagnostic biomarkers, novel therapies against NPSLE, and additional research needs.

There is growing evidence of neurological involvement in patients with coronavirus disease 19 (COVID-19), suggesting that Guillain-Barre syndrome (GBS) can also occur with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a neurological complication. Herein, we describe a unique case of a 45-year-old male who manifested with sudden onset progressive symmetric ascending paralysis leading to quadriplegia one week after developing fever, cough, and dyspnea. On examination, he had areflexia in lower limbs and hyporeflexia in upper limbs. Hypoesthesia to fine touch and vibration distal to calf was noted. His reverse transcriptase-polymerase chain reaction (RT-PCR) was positive for COVID-19, and his cerebrospinal fluid (CSF) analysis revealed albumin-cytologic dissociation. The diagnosis of GBS was made based on clinical presentation and neurophysiological studies due to COVID-19. He was commenced on intravenous immunoglobulin, and improvement in his condition was observed. He was discharged to a rehabilitation center for regular physical therapy.

Sheehan syndrome, also called postpartum hypopituitarism, is primarily caused by ischemic necrosis of the pituitary resulting from a complicated pregnancy. As the clinical presentations occur years after the complication, it is difficult to diagnose this condition. In this report, we discuss the case of a 35-year-old female with altered mental status, generalized edema, and loss of appetite. The condition was complicated due to the comorbidities of multiple medical conditions such as massive pericardial effusion and untreated jaundice. Her anorexic condition perfectly masked the malnourished appearance of the patient. After multiple laboratory tests and diagnostic imaging, the empty sella turcica of the patient propounded Sheehan syndrome. Replacement of the deficient hormones improved her condition after two weeks. Patients with complicated pregnancy history should be advised for diagnostic imaging early in life to appropriately manage Sheehan syndrome. A delay in diagnosis can have significant health and financial loss. Hormone replacement therapy is the only viable option as there is no cure to treat necrosed pituitary.

Thrombotic thrombocytopenic purpura (TTP) is a rare autoimmune and devastating blood disorder that results in micro-clots throughout the body, leading to tissue damage and organ dysfunction resulting in widespread microangiopathic hemolytic anemia, thrombocytopenia, fever, and neurological symptoms. TTP patients commonly manifest renal and neurological symptoms; however, cardiovascular involvement is not widely reported in the literature. We report a case of non-ST-segment elevation myocardial infarction (NSTEMI) as an initial manifestation of TTP. Although rare, TTP complications must be considered among other possible causes of unexpected thrombocytopenia during acute phase treatment of acute coronary syndrome because of high morbidity and mortality.

Acute pancreatitis is an inflammatory condition with varying local and systemic complications and variable severity. Although rare, cardiovascular complications induced by acute pancreatitis are rarely described in the literature. Epigastric pain with acute pancreatitis often simulates electrocardiographic changes in the absence of coronary artery abnormalities, resulting in a diagnostic dilemma for optimal treatment and management. We underline a case of acute pancreatitis complicated by acute coronary syndrome in a patient who presented with chest heaviness, dyspnea, nausea, and worsening epigastric pain associated with vomiting. Clinical and laboratory evaluations and using imaging modalities were suggestive of acute pancreatitis mimicking myocardial infarction (MI) in the absence of coronary artery abnormalities.