A case report of dysphagia and cervical muscle weakness along with predominant bulbar palsy as the initial presentation of systemic lupus erythematosus

Neuropsychiatric disorders are among the known complications of systemic lupus erythematosus (SLE). The involvement of both peripheral and central nervous systems has also been reported in SLE.Case Report: A 32 year-old woman presented with 15 days history of progressive dysphagia, the nasal intonation of voice with no significant previous medical illness. The neurologic examination showed a marked bulbar (involvement of 9, 10, 11 cranial nerves) and cervical palsy. Other systemic examinations were normal. Hematologic tests, ESR, CRP, renal and hepatic tests and a chest x-ray PA were normal. Moreover, the CSF analysis and electrophysiological studies (EMG, NCV) were normal. The ANA and Anti-ds DNA tests were positive for two consecutive times. Brain MRI revealed infarct lesions in RT cerebellar hemisphere and dorsal brainstem. A diagnosis of vasculitis secondary to liked-lupus was made based on laboratory tests and imaging. Then intravenous immunoglobulins (0.4 g/kg/day) and 0.5 g methyl prednisolone for 5 days were administered. She was discharged for the rheumatologic follow-up. It can be concluded that SLE should be considered in any patient with obscure neurological problems.