Central nervous system involvement including visual loss in a patient with systemic lupus erythematosus with posterior reversible leukoencephalopathy syndrome

摘要

A 25-year-old African American woman with no significant medical history presented to the emergency department with nausea, vomiting, acute kidney injury, and elevated blood pressure. This resulted in a complicated hospital course spanning 4 months, during which she was diagnosed with systemic lupus erythematosus (SLE) complicated by non-biopsy-proven kidney disease, pericardial effusion, pleural effusion, pancy-topenia, and seizures. At the time of diagnosis, her serology included positive antinuclear antibodies (1:10,240 speckled pattern and 1:5120 homogeneous pattern), SM greater than 8 (reference range, <1.0), SSA of 3.6 (reference range, <1.0), double-stranded DNA level of 1:640, and negative workup results for antiphospholipid syndrome (i.e., negative beta_2-glycoprotein, phosphatidylserine, and anticardiolipin). During her hospital stay, she received immunosuppressive therapy (glucocorticoids, cyclophosphamide, and rituximab), and appropriate workup for her seizures was done, which included EEG, infectious workup, lumbar puncture-all of which yielded negative results. The only significant radiologic finding at that time was a magnetic resonance imaging (MRI), which revealed a small area in the left occipital lobe showing increased uptake on diffusion-weighted images.