A Case of Refractory Systemic Lupus Erythematosus with Acute Psychosis

A case of refractory systemic lupus erythematosus was admitted with repeated tonic colonic seizures, intractable vomiting, diarrhea, and headache. Neurologic examinations, lumbar puncture analysis, and electroencephalogram were normal but magnetic resonance imaging of the brain showed dilated ventricles and sulci. Despite standard induction therapy, the patient gradually entered a confusional state, disorientation that changed to abnormalities in verbal and working memory, and finally no verbal communication for several days and avoided eating food and taking oral drugs. The patient achieved partial remission of the disease (improved symptoms of psychosis and renal function despite a high titter of anti-double strand DNA and positive anti-nuclear antibodies) with plasmapheresis, intravenous immunoglobulin, and anti-psychotic medication. Our case is interesting because he was refractory not only to standard treatments, but also he did not respond to therapeutic options that are used in refractory systemic lupus erythematosus and presented with psychosis that is an unusual clinical presentation in SLE.