Difficulties of differential diagnosis of brain alteration in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome

Overview

The authors present a case report of 36-year-old patient suffering from serious neurological symptoms. At first, manifestation of ischemic cerebral infarction appeared, which was followed by epileptic convulsions. Finally a diagnosis of systemic lupus erythematosus (SLE) with renal, endocardial, and neuropsychiatric involvement was established together with secondary antiphospholipid syndrome (APS). It was difficult to distinguish the etiology of central nervous system (CNS) alterations attested by hyperintense lesions on MRI, while there were many risk factors of atherogenesis present (male sex, positive family history, corticosteroid treatment, hypertension, and smoking). SLE vasculitis or antiphospholipid antibody induced vasculopathy with subsequent microinfarcions is the most likely explanation. However, arterial hypertension or atherosclerotic induced ischemic lesions within the white matter have to be considered as well.

Key words:
systemic lupus erythematosus, antiphospholipid syndrome, accelerated atherosclerosis, CNS alteration, magnetic resonance image