Abstract
A 24-year-old Japanese woman visited our hospital complaining of arthralgia and a facial eruption. She had been diagnosed with systemic lupus erythematosus (SLE) at the age of 15 and treated with oral prednisolone, but she had discontinued the treatment 4 years previously. Physical examination revealed a butterfly rash, photosensitivity, and swelling of the knees, ankles, and fingers bilaterally. We made a diagnosis of acute exacerbation of SLE and reinstituted oral prednisolone at 40 mg/day. The treatment was effective and reduced her symptoms, but she suddenly developed right-sided hemiparesis on the 21st day of the treatment. Laboratory investigations revealed that she was positive for lupus anticoagulant, and magnetic resonance imaging (MRI) revealed cerebral venous thrombosis (CVT). These findings suggested that her condition was caused by antiphospholipid syndrome accompanied by SLE. Anticoagulant therapy (heparin sodium and warfarin) and intravenous methylprednisolone (1000 mg/day) improved the hemiparesis. MRI after these treatments showed recanalization of CVT, and recurrence was not observed. CVT might occur in patients with exacerbation of SLE ; therefore, we should be vigilant for CVT in this setting.
