SHM Converge Scientific Abstract ePoster Gallery-A Story of Lupus Chorea in an Elderly Patient.

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This case describes a 70-year-old man who developed new-onset right-sided chorea without weakness, sensory loss, speech or visual symptoms, rash, or joint pain. Workup showed ischemic changes in the basal ganglia on MRI, mild generalized slowing on EEG, and a normal CSF without infection or inflammation. Huntington’s disease testing was negative.<br /><br />Laboratory studies supported a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid antibody positivity: ANA was homogeneous at 1:640, anti-dsDNA was positive, complement C4 was low, lupus anticoagulant was elevated, beta-2 glycoprotein I antibodies were markedly elevated, and anticardiolipin IgA was positive. He met American College of Rheumatology criteria for SLE.<br /><br />The report highlights that lupus-associated chorea is a rare neuropsychiatric manifestation and may be the first or only sign of SLE, even in elderly patients. Its exact mechanism is uncertain, but may involve inflammatory, thrombotic, vascular, neuronal, or glial injury. The presence of antiphospholipid antibodies may contribute to both neurologic symptoms and increased arterial thrombosis risk.<br /><br />Treatment recommendations from EULAR include corticosteroids with or without immunosuppressive therapy, and anticoagulation should be considered when appropriate. In this case, the patient was started on prednisone 1 mg/kg/day but showed no recovery. He declined additional immunosuppressive treatment, and delayed diagnosis/treatment likely contributed to persistent neurologic deficits.<br /><br />The case emphasizes the importance of considering SLE in elderly patients with unexplained chorea and acting quickly to prevent irreversible neurologic damage.

Asset Subtitle

Faiza Javed

Meta Tag

Author List Faiza Javed, Paramarajan Piranavan, Shivam Champaneria

Category Clinical Vignettes

Concept Chorea

Concept Systemic Lupus Erythematosus

Concept Neuropsychiatric Disease

Concept Antiphospholipid Antibody Syndrome

Concept ANA

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Faiza Javed

Track Adult

Keywords

systemic lupus erythematosus

lupus chorea

antiphospholipid antibodies

basal ganglia ischemia

elderly chorea

neuropsychiatric lupus

anti-dsDNA

lupus anticoagulant

corticosteroid treatment

irreversible neurologic damage

Chorea

Systemic Lupus Erythematosus

Neuropsychiatric Disease

Antiphospholipid Antibody Syndrome

ANA