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CNS involvement in systemic lupus erythematosus: a case with remarkable histopathological findings
  1. M J Rooda,
  2. J F Havermanb,
  3. S G van Duinend,
  4. F C Breedvelda,
  5. J J G M Verschuurenc,
  6. T W J Huizingaa
  1. aDepartment of Rheumatology, bDepartment of Pathology, cDepartment of Neurology, Leiden University Medical Centre, Leiden, The Netherlands, dDepartment of Rheumatology, Bosch Medicentrum, 's Hertogenbosch, The Netherlands
  1. Dr T W J Huizinga, Leiden University Medical Centre, Department of Rheumatology, C4-R, PO Box 9600, 2300 RC Leiden, The Netherlandst.w.j.huizinga{at}lumc.nl

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Case report

A 38 year old man was admitted in a subcomatose condition. According to the accompanying family, his current state had developed the night before. The patient was known to have had systemic lupus erythematosus (SLE) for 10 years. The diagnosis was based on a history of characteristic skin lesions, pleuritis, pericarditis, arthritis, antinuclear antibody, anti-Sm antibody, and hypocomplementaemia. His spleen had been removed in his adolescence as treatment for idiopathic thrombopenic purpura, diagnosed before the onset of SLE. Currently, he was taking 10 mg prednisone daily, started a week ago because of deteriorating skin lesions.

Physical examination showed a Glasgow Coma Score of 1-4-2. His body temperature and blood pressure were normal. Abdominal and thoracic examination did not disclose abnormalities. No signs of meningeal inflammation were present. The pupils were equally large and reacted adequately to light stimuli. Symmetrical retractions of the limbs occurred after inflicting pain stimuli. The right sided reflex of the quadriceps was higher than the left. A right sided Babinski's sign was noted. At the emergency ward the patient developed tonic-clonic seizures.

Laboratory testing showed an erythrocyte sedimentation rate (ESR) of 32 mm/1st h and a normal haematological survey. Antinuclear antibodies and anti-dsDNA were present and no …

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