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.