Unusual Headaches Revealing Neurolupus In Lome: Case Report And Review Of Literature

Abstract

Systemic lupus erythematosus (SLE) is a chronic idiopathic autoimmune disease that affects various organs, including the central nervous system (CNS) and peripheral nervous system (PNS). Neurological and psychiatric manifestations of systemic lupus erythematosus or neurolupus (NPSLE) may present as a headache. We report a case of neurolupus characterized by diagnostic wandering. The patient, a 38-year-old woman, was admitted because of persistent headaches refractory to analgesics in the context of chronic headaches that had developed since adolescence diagnosed as migraine. Her personal medical history was marked by pyrosis, polyarthralgias, dermatosis. She was admitted to the hospital with right hemicorporeal paresthesias and worsening headaches, and the clinical examination found hyperreflexia, a malar rash, multiple hypochromic sequelae lesions of dermatosis in all 4 limbs. Brain MRI showed a non-systematised left parieto-occipital lesion on T1 isosignal, T2 and FLAIR hypersignal, not enhanced by gadolinium. The cerebrospinal fluid showed a relative hyperproteinorrhea, the presence of red blood cells (05/mm³), and leukocytes (46/mm³). Blood biology found an inflammatory syndrome with moderate anaemia, an accelerated sedimentation rate of 100 mm at the first hour, a C-Reactive Protein (CRP) at 22.8 g/l (normal less than 5 g/l), positive rheumatoid factors, positive antinuclear antibodies in the indirect immunofluorescence assay (on Hep 10-20 slides), at a titer of 1/320, negative deoxyribonucleic acid antibodies and positive anti-Smith antibodies. The diagnosis of SLE was confirmed based on the American College of Rheumatology (ACR) criteria with a score of 23. Excluding primary and secondary headaches, the patient's headaches satisfied the criteria for NPSLE. She was treated with corticosteroids and then methotrexate. After 3 months of treatment, a regression of headaches and cerebral signal abnormalities was noted.