PDF(Pubmed)
Abstract：
Neuropsychiatric systemic lupus erythematosus (NPSLE) is a complication of systemic lupus erythematosus with diverse clinical presentations sharing common features with variable neurologic disorders. Magnetic resonance imaging (MRI) may provide imaging evidence of structural brain abnormalities associated with symptoms of NPSLE. Serotonin syndrome is a toxidrome characterized by altered mental status, autonomic hyperactivity, and neuromuscular abnormalities. It is mostly caused by medications that increase serotonin and is rarely reported as a manifestation of neuropsychiatric lupus. We presented the case of a 24-year-old Taiwanese woman with a history of systemic lupus erythematosus diagnosed at 21 years of age. The initial clinical and laboratory presentations upon diagnosis included fever, arthritis, hypocomplementemia, positive antinuclear antibody, anti-double-stranded DNA antibody, and anti-ribosomal P antibody. Her condition once remained stable under oral glucocorticoids and immunosuppressants, but she developed sudden-onset consciousness disturbance, incoherent speech, and unsteady gait ten days before our assessment. A high fever of up to 39 °C with tremor and clonus occurred at the intensive care unit. Brain MRI revealed symmetric T2 hyperintensity without diffusion restriction over the bilateral globus pallidus. High-dose pulse glucocorticoid and rituximab were prescribed during her admission and the neuropsychiatric symptoms diminished upon treatment. No alternation in mental status or involuntary movements were noted at follow-up. Our patient was diagnosed with neuropsychiatric lupus, with clinical symptoms and image findings mimicking those of serotonin syndrome. Neuroimaging, such as MRI, detects various structural brain abnormalities and may provide pathophysiological evidence of clinical manifestations.
摘要：
神经精神系统性红斑狼疮（NPSLE）是系统性红斑狼疮的并发症，具有多种临床表现，与各种神经系统疾病具有共同特征。磁共振成像（MRI）可以提供与NPSLE症状相关的结构性脑异常的影像学证据。5-羟色胺综合征是一种以精神状态改变为特征的毒物，自主神经活动过度,和神经肌肉异常。它主要是由增加5-羟色胺的药物引起的，很少报道为神经精神狼疮的表现。我们介绍了一名24岁的台湾妇女的病例，该妇女在21岁时被诊断出患有系统性红斑狼疮。诊断后的初始临床和实验室表现包括发热，关节炎,低补体血症,抗核抗体阳性，抗双链DNA抗体,和抗核糖体P抗体。她的病情曾经在口服糖皮质激素和免疫抑制剂下保持稳定，但她突然出现意识障碍,语无伦次,在我们评估前十天，步态不稳定。在重症监护病房发生了高达39°C的高烧，伴有震颤和阴部。脑MRI显示双侧苍白球上对称的T2高强度无扩散限制。入院时服用大剂量脉冲糖皮质激素和利妥昔单抗，治疗后神经精神症状减轻。随访中未发现精神状态或不自主运动的改变。我们的病人被诊断出患有神经精神狼疮,临床症状和影像表现模仿血清素综合征。神经影像学,比如核磁共振,检测各种脑结构异常，并可能提供临床表现的病理生理证据。
