Sensory neuronopathy complicating systemic lupus erythematosus: a case report

Abstract

Introduction: Systemic lupus erythematosus is a multi-system connective tissue disorder. Peripheral neuropathy is a known and underestimated complication in systemic lupus erythematosus. Ganglionopathy manifests when neuronal cell bodies in the dorsal root ganglion are involved. Autoimmune disorders are a known etiology, with systemic lupus erythematosus being a rare cause.

Case presentation: A 32-year-old South Asian woman presented with oral ulceration involving her lips following initiation of treatment for a febrile illness associated with dysuria. She had a history of progressively worsening numbness over a period of 4 months involving both the upper and lower limbs symmetrically while sparing the trunk. Her vibration sense was impaired, and her reflexes were diminished. For the past 4 years, she had had a bilateral, symmetrical, non-deforming arthritis involving the upper and lower limbs. Her anti-nuclear antibody and anti-double-stranded deoxyribonucleic acid status were positive. Although her anti-Ro antibodies were positive, she did not have clinical features suggestive of Sjögren syndrome. Nerve conduction studies revealed sensory neuronopathy. A diagnosis of systemic lupus erythematosus complicated by sensory neuronopathy was made. Treatment with intravenous immunoglobulin resulted in clinical and electrophysiological improvement.

Conclusion: Peripheral neuropathy in systemic lupus erythematosus can, by itself, be a disabling feature. Nerve conduction studies should be considered when relevant. Neuropathy in systemic lupus erythematosus should be given greater recognition, and rarer forms of presentation should be entertained in the differential diagnosis when the clinical picture is atypical. Intravenous immunoglobulin may have role in treatment of sensory neuronopathy in systemic lupus erythematosus.

Figure 1

Patient summary report of preliminary nerve conduction study taken at time of presentation shows electrophysiological parameters suggestive of sensory neuronopathy. [NCV-nerve conduction velocity, EMG-electromyogram, NCS-nerve conduction study, NCV N.D- nerve conduction velocity normal distribution, SLE- systemic lupus erythematosus, PN- peripheral neuropathy, R- right, L - left].

Figure 2

Post intravenous immunoglobulin nerve conduction study shows relative improvement in sensory electrophysiological parameters in comparison to preliminary findings of sensory neuronopathy. [NCV-nerve conduction velocity, EMG-electromyogram, NCS-nerve conduction study, NCV N.D- nerve conduction velocity normal distribution, IVIG- intravenous immunoglobulin, R- right, L - left].