The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Case Review: Lupus Patient with Acute Disseminating Encephalomyelitis

Case Review: Lupus Patient with Acute Disseminating Encephalomyelitis

January 19, 2018 • By Teresa Sosenko, MD, Anca Musetescu, MD, PhD, Neha Gandhi, MD, Scott Friedstrom, MD, & Diana Girnita, MD, PhD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Systemic lupus erythematosus (SLE) is an autoimmune-mediated rheumatic disease characterized by multisystem involvement that can cause significant morbidity and mortality. Acute disseminated encephalomyelitis (ADEM) is a rare, fulminant, autoimmune-mediated, demyelinating disease involving the white matter of the central nervous system (CNS), and is considered a manifestation of neuropsychiatric lupus.

You Might Also Like
  • Rheumatology Case Report: Bullous Lesions in Patient with Lupus
  • Autoimmune Myelofibrosis: A Case Review
  • Granulomatosis with Polyangiitis: A Case Review
Explore This Issue
January 2018

Few reported cases involve SLE and ADEM occurring simultaneously. Some of these cases were preceded by an infection, but others had no identifiable cause. One 2015 study suggests SLE can present as ADEM, because both occur due to abnormal immune regulation.1 ADEM with lupus rarely appears in the literature, and ADEM as the initial presentation is even rarer.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

We present one such case below.

Case Presentation

A 21-year-old African American male appeared in an emergency department with pain in his left calf, initially thought to be cellulitis. A few days after his initial evaluation, he was diagnosed with deep vein thrombosis (DVT), which was treated with apixaban.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

One week later, he again required medical attention, and this time he was admitted for a 104ºF fever, chest pain and shortness of breath. A computerized tomography (CT) pulmonary angiogram performed to look for possible pulmonary embolism revealed a large pleural effusion and possible pneumonia. The patient was treated with broad-spectrum antibiotics and anticoagulation medications, and discharged home when clinically stable.

Only one day after his discharge from the hospital—roughly three weeks after his initial emergency department visit—the patient developed a severe headache over the temporal area and shortly after became minimally responsive with left-side paresis. The physical exam in the emergency department noted confusion, difficulty following commands, subconjunctival and periorbital edema, and left-side paresis.

The history, obtained mostly from his family, reported the patient had not complained about recent visual changes, nausea, vomiting or diarrhea; hadn’t traveled recently; and hadn’t recently changed sexual partners. Per their best knowledge, he didn’t suffer from malar rash, photosensitivity, discoid rash, oral/nasal ulcers, hair loss, arthritis, a history of serositis (i.e., chest pain, shortness of breath and a history of pleuritis or pericarditis), renal failure, seizures or psychosis, foot or wrist drop, cranial nerve palsy, blood count drops (e.g., anemia, leukopenia, lymphopenia, thrombocytopenia, etc.), Raynaud’s, dry mouth or dry eyes. The family also denied the patient was using any intravenous (IV) drugs or medications.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

His family history was positive for possible rheumatoid arthritis and discoid lupus in the patient’s maternal grandmother.

Table 1: The Patient’s Infectious Disease Evaluation

(click for larger image)
Table 1: The Patient’s Infectious Disease Evaluation

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Conditions, Meeting Reports, SLE (Lupus) Tagged With: ACR/ARHP Annual Meeting, brain, Clinical, Diagnosis, drug, lab test, Lupus, magnetic resonance imaging, MRI, outcome, patient care, prednisone, psychological disorder, rheumatologist, rheumatology, Systemic lupus erythematosus, Treatment, X-rayIssue: January 2018

You Might Also Like:
  • Rheumatology Case Report: Bullous Lesions in Patient with Lupus
  • Autoimmune Myelofibrosis: A Case Review
  • Granulomatosis with Polyangiitis: A Case Review
  • Chronic Fatigue Syndrome: Why Myalgic Encephalomyelitis Is the Preferred Term and More

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.