Psychosis and Parkinsonism as the Only Initial Features of SLE in an Elderly Female – A Case Report

Abstract

Background: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that may affect any organ of the body. The American College of Rheumatology (ACR) defines 19 neuropsychiatric syndromes that can be directly attributed to SLE, including psychosis and movement disorder, which is most commonly chorea. Parkinsonism is exceedingly rare as a manifestation of neuropsychiatric SLE. The infrequent occurrence of parkinsonism in SLE and the lack of specific confirmatory tests can pose significant diagnostic challenges.

Purpose: To describe an elderly female who presented with psychosis and acute-onset parkinsonism as the only initial clinical features of SLE.

Research Design: Case report.

Study Sample: A 65-year-old woman without prior autoimmune disease who presented with new-onset psychosis and rapidly progressive parkinsonism.

Data Collection and/or Analysis: Clinical presentation, laboratory testing, neuroimaging, treatment course and response were reviewed and summarized.

Results: The patient developed new-onset psychosis and parkinsonism. Initial imaging and CSF studies were non-diagnostic, but she later demonstrated positive anti-nuclear antibody (ANA), anti-Sm and low complement levels. She was successfully treated with plasmapheresis and immunosuppressants with complete symptom resolution.

Conclusions: Psychosis and parkinsonism may be early or isolated manifestations of SLE. It is important to consider SLE and autoimmune conditions as part of the differential diagnosis in select patients presenting with psychosis and acute-onset parkinsonism as early recognition and timely immunomodulatory therapy can result in complete clinical recovery.