1981 Volume 33 Issue 3 Pages 440-447
Internal Medicine, Saiseikai Izuo Hospital, Osaka, Japan Collagen diseases, especially systemic lupus erythematosus (SLE), are often accompanied by psychoneurological disorders. But, it is a rare instance that these disorders appear prior to the physical symptoms. In such cases, as to the correlation between the collagen diseases and the antecedent psychoneurological disorders, several possibilities should be considered, although definite conclusion may not always be obtained.
We have recently experienced such fo ur cases as follows:
Case 1: T. Y.,40 y. o., female. (Table 1)
The patient was diagnosed as thrombocytope nic purpura, and also as epilepsy eight and six years ago respectively. After six years administration with phenobalbital alone, leucopenia, thrombocytopenia and seral anti-DNA antibody (×160) have been detected.
In this case, a possibility that the prior epilepsy (grand mal) and the status suspicious of collagen disease, especially SLE, have developed relatedly should be preferred to other possibilities.
Case 2: N. E.,50 y. o., male. (Table 2)
After treatment with diphenylhydantoin and phenobalbital under the diagnosis of epilepsy (grand mal) for thirty-four years, the patient obtained complains of fever, polyarthralgia and butterfly erythema. Laboratory examinations revealed ANA (×320), Anti-DNA antibody (×80), BFP (+), while CHSO being normal.
In this case, diphenylhydantoin ind uced SLE should be most preferable as the diagnosis.
Case 3: T. T.,44 y. o., female (Table 3)
The patient has been showing schizophren ia-like psychopathy since 24 to 25 years of age, i. e.7 to 8 years antecedent to the diagnosis of SLE, which was established on the basis of symptoms and signs, i. e. fever, butterfly erythema, positive LE phenomenon, ANA (×648), Anti-DNA antibody ( x 160), low CHSO, anemia, leucopenia, thrombocytopenia, and proteinuria. Corticoid therapy resulted improvement of her physical laboratory findings except for psychopathy. In spite of her psychopathic disposition (her grandmother: mental disease), the possibility of SLE initiating with antecedent symptomatic psychopathy should be most preferable as the diagnosis.
Case 4: M. T.,54 y. o., female. (Table 4)
A depressive psychopathic state appeared, accompanied by fever and skin eruption. Her laboratory findings such as anemia, leucopenia, ANA (×640), Anti-DNA antibody (×29), RA BFP (+), low CHSO, Microsome test ×6400, and Thyroid test ×400 suggested SL E. Thereafter, her psychopathic state fluctuated concomitantly with her physical and laboratory abnormalities. Corticoid administration resulted subsequent improvement of all of the abnormal findings including the psychopathic disorder. In this case, the psychopathy ma y seemed to be a symptomatic psychosis, while her psychopathic disposition was suggested by her family history, i. e. her sister had schizophrenia.
