A Flare of Systemic Lupus Erythematosus Disease After COVID-19 Infection: A Case of Lupus Cerebritis

Abstract

The association between coronavirus disease 19 (COVID-19) and autoimmune disease has been mounting, and literature on COVID-19-induced flare-up of systemic lupus erythematosus (SLE) disease is lacking. We describe a case of lupus cerebritis triggered by COVID-19 in a young female with SLE, who presented with fluctuated mentation, psychomotor retardation, slow speech, and intermittent choreiform movement in the upper part of the body. She had a history of COVID-19 infection three weeks back. Her serum immunoglobulin G antibodies were positive against COVID-19. On examination, she had psychomotor agitation, intermittent choreiform movements of upper limbs, and poor speech. Brain magnetic resonance imaging revealed hyperintense signals in the white matter of both hemispheres, suggestive of lupus cerebritis secondary to COVID-19 infection and lack of any other identifiable risk factor. Management included methylprednisolone, prednisone, and olanzapine. The patient was also placed on monthly intravenous cyclophosphamide, and her condition started improving gradually.

A Lupus Flare Case, After Infection With COVID-19

“…It is also noted a production of antibodies like ANA, antiphospholipid antibody, ANCA, anti CCP, Ro/SSA; which are thought to play a part in SLE exacerbation. (Gazzaruso et al, 2020;Gracia-Ramos et al, 2021;Zamani et al, 2021) In literature, this is not the only case describing this association (Khalid et al, 2021;Alharthy et al, 2020). This can explain the SLE disease aggravation after infection with Covid-19, as in our clinical case, along with severe organ involvement.…”

A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient

“…Additional symptoms and risks include severe metabolic syndrome, acute renal injury, neurological diseases, cardiovascular and thromboembolic events such as encephalopathy, seizures, and stroke [ [6] , [7] , [8] , [9] , [10] ]. A possible relationship between COVID-19 and autoimmune diseases such as SLE has also been recently documented in many case reports within the literature [ [11] , [12] , [13] ]. However, there is a lack of data and knowledge on LN in conjunction with MCTD in COVID-19 positive patients.…”

The Case of a Patient with Limited Systemic Sclerosis and Interstitial Lung Disease Overlapping with Systemic Lupus Erythematosus

“…Data about the association between COVID-19 and SLE [45][46][47] or SSc [13,48,49] are scarce. However, there have been reports in the literature of COVID-19 shortly preceding a de novo diagnosis of SLE, presenting concomitantly, mimicking or worsening SLE manifestations, raising the possibility of SARS-CoV-2 being an autoimmunity trigger [50][51][52][53][54][55]. There are a few critical points of convergence between SLE and COVID-19 and they are: (1) type I interferons (IFNs) (which play a crucial role in the course of disease and outcomes of COVID-19, while patients with SLE have elevated circulating type I IFN or show overexpression of type I IFN genes in circulating immune cells); (2) neutrophil extracellular traps (NETs= web-like chromatin fibers with microbicidal proteins enhance inflammation and type I IFN responses in SLE, potentiate thrombosis in antiphospholipid syndrome and recent studies have suggested its key role in COVID-19); (3) complement system (dysregulation is a classic feature of SLE, and hypocomplementemia is a marker of disease activity; complement activation has been also associated with the excessive inflammatory response seen in patients with severe COVID-19); and (4) mechanistic (mammalian) target of rapamycin (mTOR-regulates T-cell and macrophage differentiation, and is thought to play a critical role in the pathogenesis of autoimmune and inflammatory diseases, such as SLE; mTOR signaling has been shown to be decreased in pDCs from COVID-19 patients, which may negatively impact the host antiviral response [56]).…”