Focal neurological deficits due to a contrast enhancing lesion in a patient with systemic lupus erythematosus: case report and review of literature

Abstract

Neuropsychiatric (NP) systemic lupus erythematosus (SLE) is a complex entity comprising 19 different discrete syndromes. We report a case of a 32-year-old female with SLE and new onset neurological symptoms and radiographic evidence of a contrast enhancing lesion on brain MRI. The lesion was successfully excised and found to be granulomatous in nature. Infection and malignant etiologies were ruled out suggesting that the lesion was due to SLE. Subsequently, the development of multiple reversible hyperintense signal abnormalities on brain MRI suggested the possibility of posterior reversible encephalopathy syndrome (PRES). The lesions resolved after the withdrawal of immunosuppression. This article reviews both the clinical and pathological complexity of PRES in SLE and the state of the current literature. We conclude that more data is required to understand the spectrum of PRES and its management in SLE patients.