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 cyclophosphamide.

Rectal temperature was 38.5°C without signs of meningeal irritation. Orientation and attention were …