Lupus leukoencephalopathy simulating progressive multifocal leukoencephalopathy

Abstract

Lupus neurological manifestations are various. Authors report a lupus leukoencephalopathy case simulating a progressive multifocal leukoencephalopathy (PML). Female patient of 32 years old, hospitalized in internal medicine for a long-term fever exploration. Clinical examination found a symmetrical inflammatory peripheral joint syndrome, alopecia and facial erythema in verspertilio. Laboratory tests found: severe normotic regenerative anemia (Hb=4, 9 g/dl), Erythrocyte Sedimentation Rate accelerated to 80 mm. Proteinuria was at 1630 mg/24 hours. This clinical situation led to suspect a systemic lupus. A 500 mg/24 h of Methylprednisolone bolus was started because kidney biopsy is not feasible in our context, relayed by 1 mg/kg/day of prednisone and a transfusion. The evolution was complicated from flaccid tetraplegia. Brain scan found diffuse and asymmetric white matter lesions that suspect a PML. HIV status was negative and the immunological assessment revealed antinuclear antibodies at 1/1280 homogeneous and speckled fluorescence; native Anti-DNA and ENA (Anti-Sm, Anti-SSA, Anti-RNP) were positive. This assessment confirms a systemic erythematosus lupus. She received daily 400 mg of Hydroxychloroquine in combination with corticosteroid therapy. Evolution was favorable in two weeks with normalization of motor skills. Control CT scan was normal. The diagnosis of Leucoencephalopathy of lupus origin was therefore retained.