Acute psychosis as the presenting manifestation of lupus

Abstract

Neuropsychiatric manifestations like cognitive dysfunction, peripheral neuropathy, stroke headache, seizures in systemic lupus erythematosus (SLE) are quite common. However, psychosis as the sole presenting manifestation of SLE is rarely encountered clinically. If lupus is not kept as differential among patients with acute psychosis, delay in diagnosis and subsequent mismanagement are likely to happen. Here, we present a case of a young female presenting with acute psychosis as the predominant symptom and was further evaluated and diagnosed as a case of SLE. The patient was managed with immunosuppressive agents and carried an excellent outcome.

Neuropsychiatric Systemic Lupus Erythematosus: A 2021 Update on Diagnosis, Management, and Current Challenges

“…Antidepressants and anxiolytics are also often used, and their use reported positive outcomes in improving cognitive functions in SLE patients with anxiety and depression; however, their use in mood disorders is variable [ 37 ]. The use of antiepileptics for seizures in SLE has shown favorable efficacy, and antipsychotics are used for SLE psychosis [ 38 , 39 ]. Cognitive dysfunction in SLE is managed with a meta context behavioral rehabilitation strategy.…”

“…However, NSAID use in SLE is associated with an increased incidence of recurrent aseptic meningitis [ 43 ]. Ischemic NPSLE is managed with anticoagulation and antiplatelet therapy, particularly if the patients have positive antiphospholipid antibodies [ 39 ]. In most patients, inflammatory and ischemic NPSLE coexist; authors suggest using a combination of therapies, including immunosuppressive, anticoagulation, and antiplatelet therapy [ 35 ].…”

Psychotic symptoms in a patient with Systemic Lupus Erythematosus: A diagnostic dilemma between lupus psychosis and steroid induced psychosis

“…Neuropsychiatric manifestations in SLE may be due to the disease itself or drugs used to treat it (glucocorticoids, Chloroquine) or exacerbation of pre-morbid psychiatric condition [ 10 , 11 ]. These include acute confusional state, psychosis, mood symptoms, anxiety disorder, seizures, cognitive dysfunction, delirium, headache, movement disorder, etc [ 12 , 13 ].…”

“…Likewise, the former is found to be associated with high level of antibodies to p-ribosomal proteins, increase in cerebrospinal fluid IL-6, serum anti Sm antibody and antiphospholipid antibodies [ 18 ]. Study of steroid dosage (prednisolone equivalent>40 mg/day), time interval (within one to two weeks of initiation of therapy) and duration of mental changes (improvement with tapering of steroids) can be helpful [ 10 , 19 ].…”

Lupus and the Nervous System: A Neuroimmunoloigcal Update on Pathogenesis and Management of Systemic Lupus Erythematosus with Focus on Neuropsychiatric SLE

“…Anxiolytics and antidepressants are also used to improve cognitive skills in SLE patients with anxiety and depression; however, their use in mood disorders is inconsistent [106]. Effective antiepileptics and antipsychotics are used to treat SLE psychosis and seizures, respectively [107,108]. The cognitive dysfunction caused by SLE is managed to utilize a technique known as meta-context behavioral rehabilitation.…”