A Severe Case of Lupus Cerebritis

Objective Lupus cerebritis is a rare but potentially fatal complication of SLE. Prompt diagnosis and rapid initiation therapy can prove lifesaving. Background We present the case 31-year-old woman who presented to emergency department with one week fevers, headaches confusion. Review systems was notable for diffuse muscle joint pains, weakness rash. SLE Sjogren's were both diagnosed six months prior admission treatment included prednisone, methotrexate, hydroxychloroquine. She self-discontinued weeks seek natural remedies in her native Ecuador. Vitals on 102.2 F, 111 beats/min, 96/67 mmHg, 16 breaths/min 95% SO2 2 L/min via nasal cannula. Physical exam conjunctival injection, hypopyon (OD), oral ulcers visible bleeding. Pelvic showed shallow ulcerations vaginal mucosa. Neurological significant weakness. There punched-out digits hands. Laboratory markers lupus disease activity markedly abnormal. An MRI brain numerous punctate foci restricted diffusion supra infratentorial parenchyma. Few lesions subtle rim-enhancement microhemorrhagic foci. CSF analysis 220 WBC/mL (70% PMNs), glucose 13 mg/dL protein 63.7 mg/dL. No oligoclonal bands detected. CSF/serum albumin index mild impairment blood barrier. Cultures CSF, blood, urine sputum no growth. Design/Methods NA. Results The patient improved significantly upon pulsed corticosteroids, plasma exchange, cyclophosphamide. transitioned steroid-sparing agents doing well. Conclusions be dominant syndrome presenting uncontrolled Imaging findings dramatic evoke infectious syndromes. Once alternative diagnoses have been ruled out should managed aggressively ensure good outcomes.