Neuropsychiatric lupus in a Nigerian teenager

Abstract

This case report highlights the occurrence of neuropsychiatric lupus in a teenager with Systemic Lupus Erythematosus (SLE). The diagnosis of SLE was made based on the American College of Rheumatology (ACR) classification criteria. She presented with a history of fever, polyarthralgia, malar rash, pharyngitis, abdominal pain, discharging ears with reduced auditory function. She also had a history of fatigue, myalgia, weight loss, facial swelling, cough and hair loss. She had persistent headache, anxiety, confusion and generalized tonic clonic seizures. Essential findings on examination were those of distress on account of pain and difficulty with breathing, bilateral inguinal lymphadenopathy and a pulse rate of 118 beats/min.

Her laboratory results revealed a positive anti nuclear antibody (1:>5120) with a fine speckled pattern, positive anti double stranded DNA (>300 IU/ml), anaemia (Hb 7g/dl; PCV 21%), mean corpuscular volume of 66Fl, white blood cell count of 3.5 x 10⁹, a normal platelet count, a negative rheumatoid factor, erythrocyte sedimentation rate of 123mm/ HrWestergren. She had proteinuria (1+) with an essentially normal serum, electrolytes urea and creatinine.

Keywords: Systemic lupus erythematosus, Neuropsychiatric, Anti nuclear antibody