INTRODUCTION: Neuropsychiatric systemic lupus erythematosus (NPSLE) and central nervous system (CNS) infection are two significant complications of SLE where mortality is high. Differentiating the two diseases could help deliver appropriate and timely therapeutic strategies that impact mortality in patients with SLE particularly in cases where confusions due to overlapping symptoms delay early interventions. METHODS: We reviewed the medical records of SLE patients diagnosed and confined for a NPSLE at the University of Santo Tomas Hospital in Manila, Philippines, January 2015-December 2016. Informed consent was collected. CASE PRESENTATION: We report 5 cases of SLE patients (1 male; females) who presented between January 2015-December 2016 in a tertiary care hospital obtained from the SLE database of University of Santo Tomas (UST) Hospital Section of Rheumatology. All five patients were identified to have NPSLE with following chief complaints: (case 1: 22M) seven-day history of left-sided hemiparesis, (case 2: 22F) vomiting and generalized tonic-clonic seizures, (case 3: 32F) generalized tonic-clonic seizure; (case 4: 67F)) confusion and disorientation, (case 5: 27F) progressive headache, tinnitus, nausea and blurring of vision. All patients had low complement 3 (C3) levels and were treated with steroids, and sent home improved. The challenge of discriminating the varied clinical manifestations to the possibility of underlying CNS infections were heightened by the financial limitations of necessary diagnostics needed to identify the underlying causes. CONCLUSION: Good clinical skills and appropriate diagnostics and laboratories played an important role in the five cases presented creating a clearer clinical picture and in ruling out secondary causes thus directly channeling the management in these cases.
Research