Dr. Cobb presented a case of Neuropsychiatric Lupus (NPSLE) which presented as altered mental status in a young female. From a broad system based differential for "altered mental status" we utilized our exam to hone in on autoimmune phenomena leading to NPSLE.
NPSLE can present with focal central or peripheral neurologic syndromes as well as diffuse psychiatric syndromes. The American College of Rheumatology describes 19 possible associated symptoms. It is the presenting symptom for lupus in 39-50% of cases. It is speculated to be a result of either inflammation or thrombosis/ischemia. The mainstays of therapy are IV steroids and cyclophosphasmide. However, as discussed, the new biologic agents are showing some promise. For more information: Magro-Checa et al. Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives. Drugs. 2016 Mar;76(4):459-83. PMID: 26809245.