Key points are not available for this paper at this time.
Introduction Systemic lupus erythematosus (SLE) is an autoimmune pathology with a wide spectrum of presentation. Neuropsychiatric SLE (NPSLE) refers to a series of neurological and psychiatric symptoms.1 Chorea is a rare clinical manifestation. Although it is the most common motor disorder in SLE, it remains a rare manifestation, with an incidence of 1% - 4%.2 Case Report 17-year-old female, with no pathologic personal history. Onset of headache intensity 8/10, accompanied by paresthesia and edema of thoracic limbs. Adding involuntary movements such as hemichorea and hemiballism characterized by irregular, choppy, arrhythmic and rapid movements of short duration, without added gesticulations, gait disturbance with disorganized steps, arrhythmic on the right side and agitated. Diagnostic approach is initiated with laboratories (table 1) and magnetic resonance imaging (MRI) of the brain with normal results. Lumbar puncture Cerebrospinal fluid Crenated 80% leukocytes 2 per field, PMN 50%, MN 50%, glucose 50mg/dl, pH8.0, VDRL Neg, after ruling out infectious process due to sex and age of the patient, antibodies were requested to rule out autoimmune pathology with ANAs 1:640 homogeneous, AntiDNA positive, C3 50mg/dl, C4 18mg/dl, He started treatment with dexamethasone, azathioprine, chloroquine and cyclophosphamide with remission of neurological symptoms. Subsequently, creatinine increased to 3.3mg/dl. A renal biopsy was performed and the result was class IV glomerulonephritis with activity 12/24, chronicity 4/12, with active crescents in more than 25% of glomeruli (figure 1). We started treatment with boluses of methylprednisolone and cyclophosphamide. After starting methylprednisolone boluses, the patient's creatinine decreased to 2.6mg/dl. With improvement of neurological symptoms and renal function, the patient was discharged home. Conclusion The case of our patient shows hemiballism hemichorea as a debutant symptom, we excluded infectious process (normal CSF), without pathological findings by brain MRI, we ruled out Huntington's disease and drug intoxication on questioning and clinical history. The first option was immunological since it was a young woman, and we were able to confirm the diagnosis with positive antibodies and renal biopsy. We consider that it is essential to make known infrequent clinical pictures so that we can increase our diagnostic range. References Sarwar S, Mohamed A, Rogers S, Sarmast S, Kataria S, Mohamed K, et al. Neuropsychiatric systemic lupus erythematosus: a 2021 update on diagnosis, management, and current challenges. Cureus. 2021;13(9):11–1. Song G, Cui Y, Qiao J, Cao S, Zhou Y, Zhu L. A case of systemic lupus erythematosus complicated with chorea and literature review. J. Chin. Acad. Med. Sci. 2023;45(1):161–166.
Avelar et al. (Fri,) studied this question.