A refractory case of a male patient with neuropsychiatric systemic lupus erythematosus with various psychiatric symptoms and MRI observations

Abstract

Patients with neuropsychiatric systemic lupus erythematosus (NPSLE) frequently show neurological and psychiatric symptoms. When NPSLE is comorbid with a psychiatric disorder, symptoms often overlap leading to a delayed NPSLE diagnosis. Herein, we present the case of a 39-year-old male patient presenting various neuropsychiatric symptoms, who was subsequently diagnosed with NPSLE. Severe neuropsychiatric symptoms, including persecutory delusions, visual hallucinations, depressed mood, psychomotor excitement, and cognitive impairments, persisted after NPSLE was treated with prednisolone and cyclophosphamide in combination with antipsychotics and anticonvulsants. We also discuss the changes in enhanced MRI findings that did not reflect the patient's neuropsychiatric symptoms.