Striatal dominant lupus encephalitis–Is it vasculitis or an autoimmune process? Literature review & new case report with vessel wall imaging

Neveada Raventhiranathan, Abdelmohsen Radwan Hussien, Kavya Mirchia, Amar Swarnkar, Rajiv Mangla

Research output: Contribution to journalArticlepeer-review

Abstract

Neurological and psychiatric symptoms are highly prevalent in the initial manifestation of systemic lupus erythematosus (SLE) and is classified as neuropsychiatric systemic lupus erythematosus (NPSLE). Despite the high prevalence rate of this condition, it is still very poorly understood and often delayed in its diagnosis due to its variety in clinical manifestations. For our case, an eighteen-year-old male who was recently diagnosed with SLE presented with progressive confusion, visual and auditory hallucinations, in addition to high fevers, diarrhea, abdominal and flank pain. Upon initial presentation, he was treated for sepsis while trying to identify a source of infection. However, with the help of laboratory tests like CSF analysis and autoantibody serum studies as well as neuroradiologic imaging, we were able to rule out infectious causes and diagnose our patient with lupus induced striatal encephalitis. We present the first case of striatal encephalitis with vessel wall imaging to ultimately rule out lupus associated vasculitis. The importance of MRI imaging and identification of specific patterns associated with autoimmune encephalitis allowed rapid diagnosis and initiated immediate treatment in the hopes of reducing long term affects from neuroinflammation in our young patient.

Original languageEnglish (US)
Pages (from-to)1205-1210
Number of pages6
JournalRadiology Case Reports
Volume17
Issue number4
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • 3.0 Tesla field strength
  • Bilateral basal ganglia
  • Lupus encephalitis
  • Neuropsychiatric lupus
  • Systemic Lupus Erythematosus
  • T2 FLAIR Hyperintensities

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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