Lesson of the month
Neuropsychiatric lupus?
a Departments Neuro-oncology, b and Rheumatology, c Daniel den Hoed
Cancer Centre, University Hospital Rotterdam, Rotterdam, the
Netherlands
Correspondence to: Dr P Sillevis Smitt, Department of Neuro-oncology, Dr Daniel den Hoed Cancer Centre, PO Box 5201, 3008 Rotterdam, the Netherlands.
Accepted for publication 15 October 1997
| The first 150 words of the full text of this article appear below. |
 |
Case history |
|---|
A 49 year old man with systemic lupus erythematosus (SLE) was
admitted in April 1996 with fever, headache, and mental change. In
1984, he noticed discoid changes on sun exposed skin areas. At the same
time, he developed pleuritis, myocarditis, pericarditis, haemolytic
anaemia, and myositis. Anti-dsDNA antibodies were found in his serum
and SLE was diagnosed.1 Treatment was started with
prednisone 80 mg and cyclophosphamide 150 mg. On high doses of
corticosteroids he became delusional and therefore, the prednisone was
tapered. Over the following years he was admitted several times with
relapses of his SLE manifesting as glomerulonephritis (biospy class
IV), thrombocytopenia, and leucocytopenia. In 1994 he had his latest
glomerulonephitis relapse and treatment was again started with
prednisone and cyclophophosphamide. On admission, he presented with a
three week history of headache, memory loss, and clouded thinking. For
the past two years he had been taking a stable daily dose of 7.5 mg
prednisone and 100 mg
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