Systemic Lupus Erythematosus Presenting As Mixed Sensori-motor Axonal Polyneuropathy

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that has multisystem manifestations. However, axonal polyneuropathy is rare in SLE. We report the case of a 41-years old lady who presented with gradual onset, progressively worsening bilateral lower limb weakness for 1 month along with tingling, prickling and burning sensation. There was history of dry eyes, oral ulcers, dry mouth, dental caries, lethargy and fatigue. On examination, poor oral hygiene, coarse dry tongue, oral ulcers, dental caries and conjunctival pallor were noted. Neurological examination of lower limbs revealed flaccid LMNL paralysis with paresthesia of both feet extending up to the mid-shin level. She had normochromic normocytic anemia with hemoglobin 10.8 g/dl and raised ESR 40 mm/hour. NCS revealed mixed sensori-motor axonal polyneuropathy. ANA, anti-DsDNA (138 IU/ml), Anti-Sm (>200 U/ml) and anti-Ro/SSA antibodies (146 U/ml) were positive with low serum C3 (29.3 mg/dl) and low serum C4 (07 mg/dl). She was diagnosed as SLE and started on plasmapheresis, steroids, hydroxycholoroquine and azathioprine with marked improvement at follow-up.