Two Case Reports Indicating the Dilemma in Diagnosing Lupus Cerebritis
A thirty-one-year-old woman, with an episode of generalized seizure, presented to the Emergency, with a history of low-grade intermittent fever and joint pain and swelling for a duration of one-and-a-half months. She was also suffering from irregular menstrual cycles and menorrhagia. She was diagnosed by her primary physician as a case of severe rheumatoid-arthritis with anemia.\nThe bouts of seizures continued and she required intubation. Arterial blood gas analysis showed mild metabolic acidosis. A CT scan of the brain revealed a moderate degree of cerebral edema. Treatment was initiated with the provisional diagnosis of bacterial or viral meningitis and vasculitis.\nHer level of alertness gradually deteriorated. Low-grade, intermittent fever persisted. The sepsis markers were not raised. Hemoglobin, WBC, and platelet counts were low. The CSF report revealed absolute lymphocytosis (100%) and raised protein. There were abnormal diffuse encephalitic changes in the electroencephalogram recordings. ANA by the Hep2 cell method showed a positive, homogeneous pattern. Anti DsDNA was positive. The C3 value was 88.2 mg per dl, while C4 was 21.6 mg per dl, both on the lower side of normal. Antiphospholipid antibody estimates were significant. IgG was 12.92 GPlU per ml and IgM was 3.76 MPl per ml. The final diagnosis was SLE with neuropathy, in the form of cerebritis with nephropathy, anemia, and associated disorder in the mechanism of blood clotting.\nIf we compare the two cases we find certain common features. The initial presentation was confusing. Only a high degree of clinical suspicion could lead to the diagnosis. We summarize the clinical, pathological, and biochemical similarities between the two subjects in .