Systemic lupus erythematosus presenting with slurred speech: a case report

BACKGROUND: Systemic lupus erythematosus is a chronic autoimmune disease with heterogeneous clinical manifestations. Neuropsychiatric involvement is relatively common in systemic lupus erythematosus; however, isolated dysarthria or slurred speech is an exceedingly rare presentation. Reporting such atypical manifestations may improve clinical awareness and facilitate early diagnosis of neuropsychiatric systemic lupus erythematosus. CASE PRESENTATION: A 14-year-old Iranian girl with no family history of autoimmune disease was referred to the rheumatology department with persistent fatigue, weakness, arthralgia, and progressive slurred speech, which significantly impaired her academic performance. Physical examination revealed malar rash, oral ulcers, alopecia, arthritis, and dysarthria. Laboratory evaluation demonstrated leukopenia, thrombocytopenia, hypocomplementemia (C3: 37 mg/dL, C4: 5.4 mg/dL), elevated erythrocyte sedimentation rate (132 mm/hour), positive antinuclear antibodies (1:1000), high anti-double-stranded DNA and anti-histone antibody levels, and positive antiphospholipid antibodies. Brain magnetic resonance imaging showed white matter hyperintensities in the centrum semiovale, suggestive of inflammatory or vasculitic involvement. The patient was treated with intravenous methylprednisolone followed by cyclophosphamide induction therapy and oral corticosteroids, resulting in marked clinical and laboratory improvement. Maintenance therapy with mycophenolate mofetil was initiated, and the patient remained clinically stable during follow-up. CONCLUSION: This case highlights isolated dysarthria as a rare but clinically significant manifestation of neuropsychiatric systemic lupus erythematosus. Awareness of such atypical neurological presentations may contribute to earlier recognition and appropriate management, leading to favorable long-term outcomes.