Parkinsonism as first manifestation of lupus

Lachhab, L.; Regragui, W.; Hamaz, Siham; Benhaddou, E.H. Ait; Benomar, A.; Yahyaoui, M.

doi:10.1016/j.neurol.2012.03.010

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…The rest responded to high-dose steroids and immunosuppression. However, it cannot be concluded that these patients who received additional anti-Parkinsonian medications did not improve with immunosuppression alone, as the former was started upfront in some cases, 10,14 added on in some cases when the extra-pyramidal symptoms were refractory to stand-alone immunosuppression, 13,15,[22][23][24] or added in due course of the disease without hiking steroids. 16,18 In one patient, bromocriptine and levodopa were found to be ineffective, following which lupus was diagnosed and she responded to immunosuppression.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Parkinsonism as the presenting manifestation of lupus: A case-based review

Maikap

Padhan

2023

Lupus

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Introduction Neuropsychiatric manifestations in systemic lupus erythematosus (SLE) occur in about half of the patients; however, movement disorders like Parkinsonism are rare. We describe a case of SLE who presented solely with features of Parkinsonism. Case report 50-year-old female presented with global slowing of movements and slowing of speech since 2 months. On examination, she had mask-like facies with a faint malar rash sparing the nasolabial folds, hard palate ulcer, cog-wheel rigidity, and proximal muscle weakness. Lab evaluation revealed lymphopenia, high ESR, elevated lactate dehydrogenase, creatinine phosphokinase, AST, and ALT levels. She had high anti-dsDNA levels with low complements. Urinalysis showed proteinuria and hematuria. ANA was positive at a titer of 1:320, and she had positive anti-ribosomal-P antibody. She had severe flare with a SLEDAI of 33. She was treated with pulse IV methylprednisolone followed by cyclophosphamide (NIH protocol). At 4 weeks follow-up, she had dramatic improvement in her Parkinsonian symptoms and her proximal muscle weakness. Discussion The prevalence of movement disorders in cases of neuropsychiatric SLE is very low at 0.7%, with chorea being most frequent and Parkinsonism rare. The pathogenesis is multifactorial including anti-dopaminergic antibodies or associated anti-phospholipids causing microvascular thrombosis or vasculitis of the thalamostriatal arteries or disease activity itself. As in our case, immunosuppression and optimal treatment of active lupus reverts symptoms in most cases. Conclusion A high index of suspicion needs to be exercised in cases of SLE presenting with Parkinsonism as adequate immunosuppression translates to near-complete recovery.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Parkinsonism as the presenting manifestation of lupus: A case-based review

Maikap

Padhan

2023

Lupus

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“…Brain MRI findings were heterogenous without clinico-radiological correlations. Nearly half of the cases showed no abnormalities [65,[67][68][69][70][73][74][75], whereas 37% showed deep WM T2-hyperintensities [61,66,71,[76][77][78][79]. BG calcification [62,64,71], stroke [78] or cerebral atrophy [63], were infrequently seen.…”

Section: Investigationsmentioning

confidence: 97%

“…CSF analysis was available in 15 cases. Findings were normal in 47% of cases [63,71,[75][76][77]80]. The remainder had non-specific alterations like elevated protein [61,66,79], positive IgG index [65] or pleocytosis [67][68][69].…”

Section: Investigationsmentioning

confidence: 98%

“…In 57% of cases, parkinsonism post-dated the diagnosis of SLE, by anywhere from one week to 18 years [62][63][64][65][66][67][68][69][70][71]. In the remainder, parkinsonism preceded the diagnosis of SLE up to 5 years (13%) [72][73][74], or presented together with findings suggestive of SLE (30%) [61,[75][76][77][78][79][80]. Neither age of onset nor the interval between the diagnosis of SLE and parkinsonism associated with clinical phenotype or rate of progression.…”

Section: Epidemiologymentioning

confidence: 99%

“…Blood count (available in 13 cases) demonstrated cytopenias in 85% of cases [61, 64, 66-68, 74-77, 79]. ANAs were positive in all cases [63,64,[66][67][68][69][70][71][72][73][74][75][76][77][78][79], except for the case of secondary CNS vasculitis-parkinsonism [61], and anti-dsDNAs were present in 70% of cases [63, 64, 66-68, 70-72, 74-76, 80]; aCL were positive in 40% [66,74,76,77] and LA in 50% of cases tested [64,66,68,73,76], respectively.…”

Section: Investigationsmentioning

confidence: 99%

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