Table 1 . Neuropsychiatric Syndromes of Lupus Erythematosus ^{3 , 8 , 11}

Central Nervous System Related Aseptic Meningitis Acute Confusional State Cerebrovascular Disease

Demyelinating Syndrome Headache Movement Disorder Mood Disorders Myelopathy Psychosis Seizures

sorium , and failure to respond to therapy prompted a reconsideration of her provisional diagnosis . An increased suspicion for an underlying autoimmune disorder was entertained considering this patient ’ s age , gender , dermatologic findings of facial rash , elevated serum inflammatory markers , direct Coombs positive anemia , and thrombocytopenia . Multi-organ system involvement further supported this etiology : urinalysis with hematuria and proteinuria and acute renal failure

Peripheral Nervous System Related Acute Inflammatory Demyelinating Polyraduculoneuroptht Autonomic Disorders Cranial Neuropathy Mononeuropathy Myasthenia Gravis Plexopathy Polyneuropathy

requiring hemodialysis ; heart failure with reduced ejection fraction , pericardial effusion and cardiomegaly ; bilateral pleural effusions ; and diffuse cerebral edema with new-onset seizures and rapid worsening of mental state and neurologic symptoms .

Autoimmune testing demonstrated a positive ANA screen with ANA titer > 1:1280 with a homogeneous nuclear pattern . Other findings included anti-ds DNA antibodies 725 IU / mL ; C3c 50 mg / dL , C4c

10 mg / dL ( low levels of C3 and C4 ), and positive pANCA . The diagnosis of SLE was confirmed on the ninth day of hospitalization , and she was started on high-dose IV methylprednisolone ( 1000 mg q 24 hr ) for three days and placed on hydroxychloroquine ( 200 mg q24 hr ) with subsequent rapid improvement of her neurologic status within days . Since her mental status had improved and she had remained seizure-free with steroid therapy , her anti-epileptic medication was discontinued . Because of her renal failure , a renal biopsy was performed and reported focal crescentic glomerulonephritis , Pauci-immune type ; she was subsequently started on treatment with mycophenolate 500 mg orally twice daily .

Following hospital discharge , she was seen in the clinic for a transition of care follow-up visit . She was no longer requiring treatment with anti-psychotics and anti-epileptics , as treatment of underlying SLE had improved her psychiatric and neurologic status . Moreover , her renal failure had resolved , and she no longer required hemodialysis .

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Volume 118 • Number 6 DECEMBER 2021 • 131