NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS + STROKE IN ADOLESCENT ?

RSMH
Aliana R, Santana A, Silahuddin, Almar A, Yuniza*, Kurniati N*, Salim E D* * Allergy Immunology Division of Hospital Medicine. Muhammad Hoesin / FK UNSRI Palembang SLE is a chronic autoimmune disease characterized by organs and cells damaged. Genetic, immunologic, hormonal and environmental factors role in the pathophysiology of SLE. The prevalence of SLE is 2.9 / 100 000 - 400/100.000. Mostly attacks the age of 15-40 years, : = 9: 1. Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) is a neurological syndrome of central, peripheral nervous system, and psychiatry after the other causes ruled out. Morbidity and mortality of NPSLE 18-61% of cases. Identification: Mr. RS, 27 years Chief Complaint: seizures since 3 days before admitted. History of stroke since 12 years old, his twin brother was diagnosed with nephritis lupus.

Physical examination: BP 110/70 mmHg, pulse 76 x / minute, RR 20 x / min, T 36.9 C, the malar rash face (-), discoid lesions (+), scars (+), parese of N VII, left heart: systolic murmur grade 2/6 at mitral valve, gallops (-).

History of illness: In 2004, he complained of weakness, oral sores, joint pain, and fever. He also complained of seizures, he suffered from epilepsy and had luminal therapy. In 2005 he complained of hair loss, reddish spots on the face, he suffered from lupus then received MMF, metil prednisolon, folic acid, carbamazepine and luminal. He had seizures in 2006-2009, 2-3 times a month and regularly controlled. In 2011, he had stomatitis, high fever, redness, blotches on the face and neck, joint pain and seizures. He was treated 11 days in hospital and received MMF, MTX, metil prednisolon, folic acid, CaCO3 and phenytoin. In January 2012, he complained of seizure, stiffness of neck, headache, stiff of arms and legs, then he controlled to RSMH. aPTT + mixing test 37,11+34,9 (N: 27-42) C 34,2 Fibrinogen 521 C 280 D dimer 691,7 ng/ml (<500) ACA IgM 2,0 MPL units/mL (<12) ACA IgG 2,5 GPL units/mL (<12) Anti 2 GPI IgG 0,029 SGU Anti 2 GPI IgM 5,983 SGU Neurological status: Motoric function: hemiparese spastic sinitra + parese of N VII + XII sinistra central + tonic generalized seizures e.c susp lupus cebritis, dd/sequele CVD Physiology reflexes: normal Pathological reflexes: (-) Sensoric function: normal ERM (-)

Thorax X ray: normal. ECG: Normal ECHO: MR, moderate TR. Eyes: mild Vasculitis. EEG: abnormal EEG with a slowdown in temposentral 4-5 spd, vertex central, parietal left MEX-SLEDAI score : 10

Cranial CT Scan: atrophi cerebri support the idea of neuropsychiatric lupus

Diagnosis: Sistemic Neuropsychiatric Lupus Erythematosus (NPSLE) + Hemiparese Spastic Sinistra.

Treatment: methylprednisolone 1 x 8 mg, MMF 2 x 500 mg, 2.5 mg MTX 3 x / week, Omeprazole 1 x 20 mg, Chloroquine 1 x 150 mg , CaCO3 3 x 500mg, KCL 3 x 500mg, Mecobalamin 3 x 500 mcg, phenytoin 3 x 100 mg, folic acid (anemolat) 1 x 1 mg.