Discussion:
The diagnosis of our case was hard to establish at first because the main symptoms of CNS lupus can be diffuse (generalized seizures, psychosis) or focal (stroke, peripheral neuropathies), and the patient’s symptoms were vague and nonspecific. Differential diagnosis of our patient symptoms includes hypertensive encephalopathy, toxic leukoencephalopathy caused by therapeutic agents, and metabolic causes involving the nervous system, such as hydro-electrolytic changes . The presence of ANA and anti-dsDNA and her symptoms were a strong guide to the final diagnosis. Upon literature review, we found multiple similar cases. For example, in a case reported by (Ferraria, N., et al., 2013) , a seven-year-old girl was admitted because of ataxia, diplopia, and morning vomiting. An MRI of the brain showed marked brain lesions, so the patient started on pulse immunosuppressive treatment followed with Psychotropic medications, and azathioprine was initiated as maintenance therapy. After that, the patient had clinical improvement in terms of symptoms and radiology. Another case was reported by (Iftikhar, et al., 2019), a 43-year-old female who presented to the emergency department with a seizure. She failed conventional antiepileptic medications, and Later on, she developed a malar rash which then the diagnosis of SLE was established based on refractory positive ANA, arthritis, malar rash, and seizures. So has been treated with IV methylprednisolone then maintained by rituximab, and oral prednisolone 45 mg, which tapered gradually. Later on, the patient showed good improvement in her symptoms. In another case reported by (Faruk, et al., 2013), a seven-year-old girl was admitted to the emergency because of a seizure. After confirming the diagnosis of SLE, she was treated with intravenous pulse methylprednisolone followed by oral prednisolone. After the treatment, the C3 and C4 levels returned to normal, and her symptoms improved.