Newly Diagnosed Systemic Lupus Erythematosus: Atypical Presentation With Focal Seizures and Long-standing Lymphadenopathy.

BACKGROUND

Systemic lupus erythematosus (SLE) may present with involvement of multiple organ systems, usually with a constellation of nonspecific constitutional symptoms and signs. Seizures and thrombosis are uncommon at presentation.

METHODS

We present the case of a 17-year-old boy of African descent with an 11-year history of persistent lymphadenopathy with negative outpatient workup for lymphoma and immunodeficiency who was admitted to our tertiary care hospital for new-onset seizure activity. Over the course of the initial hospital stay, the patient was found to have evidence of thrombosis in multiple organ systems with negative antiphospholipid antibody. Complications included brain hemorrhage secondary to sagittal and cortical vein thrombosis and focal neurological findings of left side weakness and seizures. Following the initiation of steroids and immunosuppressant agents, symptoms resolved, but there followed several readmissions for aggression and psychosis-like symptoms.

CONCLUSIONS

In this case, we convey the unique mosaic presentation of SLE and highlight how treatment can cloud the clinical picture, making it difficult to diagnose some SLE manifestations, such as neuropsychiatric lupus that could resemble steroid-induced psychosis.