Cerebral Venous Sinus Thrombosis as the First Manifestation of Systemic Lupus Erythematosus

A 15-year-old girl was admitted for malar rash and fever. Routine laboratory examinations revealed positive antinuclear and anti-Sm antibodies. The 24-hour urine protein was 2.73 g. The C3 level was reduced. She tested negative for antiphospholipid antibodies. She was diagnosed as systemic lupus erythematosus (SLE). Pulse methylprednisolone therapy of 80 mg was administered. Her body temperature has become normal, but she developed thrombocytopenia (38 × 109/L [125–350 × 109/L]), and she experienced transient loss of consciousness. The brain magnetic resonance venography (MRV) indicated extensive occlusion of intracranial venous sinus (Fig. 1), confirming the diagnosis of cerebral venous sinus thrombosis (CVST). Thus, she received anticoagulant therapy, and her platelet count rose to 125 × 109/L on day 5. Cranial MRV after 8 months showed that the cerebral venous sinus thrombosis had been completely absorbed (Fig. 2). CVST is a rare complication of SLE. Early diagnosis and timely treatment of CVST can significantly improve the prognosis.FIGURE 1: MRV showed the dilation of superior cerebral vein (arrow) and the occlusion of superior sagittal sinus, straight sinus, transverse sinus, sigmoid sinus, and internal jugular vein (magnetic resonance imaging [MRI] coronal position [A], MRI sagittal position [B]).FIGURE 2: Repeat MRV after treatment showed reopening of the superior sagittal sinus (red arrow), straight sinus (green arrow), transverse sinus (yellow arrow), sigmoid sinus (blue arrow), and internal jugular vein (purple arrow) (MRI coronal position [A], MRI sagittal position [B]).