Neuropsychiatric Systemic Lupus Erythematosus and Cognitive Impairment: A Complex Issue with a Dark Prognosis

Abstract

Aims: Neuropsychiatric systemic lupus erythematosus (NPSLE), may present as a wide range of symptomatology where cognitive impairment could play a key role in the prognosis of SLE patients. Presentation of Case: A 24 year-old female was admitted in 1999 in unconsciousness. Cranial MRI showed two thalamo-mesencephalic lesions and the patient was discharged home with a diagnosis of metabolic and/or toxic encephalopathy. One year later systemic lupus erythematosus was diagnosed. Following up showed memory disturbance with several strokes and atrophy in neuroimaging, and positivity of antiphospholipid antibodies. Anticoagulation was indicated with an irregular compliance. In March 2010 the patient was admitted due to generalized articular pain and hemoptoic sputum due to bad control of the anticoagulation. One month later she was admitted to Intensive Care Unit due to acute pulmonary edema and acute renal failure. In June 2010, the patient was discharged home where she died some months later. Discussion: This case reflects the complexity of NPSLE: an acute encephalopathy as an early sign of the disease, the antiphospholipid syndrome, development of progressive cerebral global atrophy and cognitive impairment, and the coexistence of another autoimmune neurological disease such as myasthenia gravis. Conclusion: The authors consider that the presence of cognitive impairment, intervening in the compliance of the treatment, could be one of the main risk factors in the prognosis of SLE patient.