Diagnosis of neurological lupus after altered mental status in the emergency room: case report

*Correspondence: [e-mail].

Abstract

Case Presentation: A.G.G.P., male, 11 years old, Caucasian, previously healthy. Admitted in emergency intubated due to decreased level consciousness (Glasgow Coma Scale = 5) after a seizure. Previously, he had intermittent fever and holocranial headache for 15 days, diarrhea and vomiting for 5 days. Complementary neurological exams, including magnetic resonance, were unremarkable. During hospitalization in intensive therapy unit, hypertension was observed since admission and urinalysis demonstrating microscopic hematuria and macroalbuminuria. In evolution, the patient presented pleural effusion, consumption of C3 (37 mg/dL) and CH50 (17.5 U/mL), hemolytic anemia, ANA-positive (1/160 fine speckled pattern), lupus anticoagulant and anticardiolipin positives, therefore the diagnosis of lupus was drawn. He presented complete recovery of the neurological symtomps, following up with rheumatology.

Discussion: Only 8-15% of systemic lupus erythematosus (SLE) presents it before the age of 16, usually more aggressively and less responsive to treatment. The predominance is higher in females even in the prepubertal age group. The average age of onset of juvenile SLE is 12 years, and the younger the age, the more likely the disease is to begin atypically. The most common initial manifestations are hematological (55-77%), dermatological (70%), and renal (27-59%). Neurological manifestations may occur in up to 2/3 of young individuals with SLE, the most common being headache, followed by seizures, psychosis, cognitive impairment, behavioral changes, and movement disorders.

Final Comments: Besides the typical organic symptoms, behind such a complex autoimmune disease there is a wide range of variants, such as cognitive alteration, anxiety disorders, and depression that correlate with disease activity. The picture of altered level of consciousness can encompass several manifestations, whether or not they are directly related to SLE. To attribute the lowered level of consciousness to the disease, other causes must be ruled out.

 

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Artikel online veröffentlicht:
12. Mai 2025