Stroke in Young Female as a Presenting Feature of Systemic Lupus Erythematosus with Central Nervous System Vasculitis and Its Management

Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disorder involving multiple systems. A 18-year-old female patient presented with complaints of headache, weakness, and tingling sensation in the left upper limb and lower limb. On magnetic resonance imaging (MRI), acute nonhemorrhagic infarct in right thalamo-capsular region was seen. The patient gave a history of malar rash and intermittent joint pains for which she had taken nonspecific treatment. Antineutrophilic antibody (ANA) by innumoflourescence and ANA blot was suggestive of SLE. Hence, the patient had central nervous system vasculitis and stroke due to SLE. The patient was started on antiplatelet therapy, tablet prednisolone 40 mg once daily, and tablet warfarin 5 mg once daily. The patient was readmitted after 2 weeks with menorrhagia and deranged INR. Tablet Warfarin was with-held, fresh frozen plasma transfusions were given. Repeat MRI did not show any new changes. Patient was given tablet nicoumalone and three doses of injection cyclophosphamide 800 mg. Hemiplegia has improved by 90%, her menstrual cycles are now regular.