Systemic Lupus Erythematosus Presenting as Walking Corpse Syndrome

Abstract

Cotard syndrome, also known as "Walking Corpse Syndrome", is a clinical entity characterized by fixed delusions that one is dead or dying. This is a neuropsychiatric manifestation of brain pathology affecting the non-dominant frontotemporal and parietal lobes, particularly the fusiform gyrus. Prior literature has indicated that the etiology of Cotard syndrome may include structural changes related to brain injury, tumors, and temporal lobe epilepsy. We now present a case in which Cotard syndrome is related to systemic lupus erythematosus (SLE). Neuropsychiatric symptoms are atypical manifestations of SLE. Delusions, hallucinations, and other psychotic symptoms can result as a consequence of the disease itself or from corticosteroid treatment. A diagnosis of SLE-induced psychosis can be elusive; however, conducting a thorough workup is crucial as untreated psychosis secondary to lupus cerebritis can worsen without intervention. We present a clinical unique case of SLE cerebritis, diagnostic challenge, and management.

Keywords: cotard syndrome; lupus cerebritis; psychosis; systemic lupus erythematosus; walking corpse syndrome.

Figure 1. Renal biopsy results. Findings consistent with focal active lupus nephritis, ISN/RPS Class III A. (A) Segmental endocapillary hypercellularity. (B) Mesangial IgG. (C) Subendothelial electron dense deposit