SHM Converge Scientific Abstract ePoster Gallery-When Seizures Signal More: Status Epilepticus Unveiling Multiorgan Lupus

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This case describes a 24-year-old woman who presented to the emergency department after a generalized tonic-clonic seizure and rapidly progressed to status epilepticus requiring intubation. Her preceding symptoms included flu-like illness, gastrointestinal upset, recurrent headaches, neck pain, gait instability, and a recent fall, suggesting a broader systemic process.<br /><br />Initial evaluation showed hypertension, sinus tachycardia, anemia, thrombocytopenia, acute kidney injury, and schistocytes on peripheral smear. CT head was negative, but MRI brain showed gyriform hyperintensities and brainstem abnormalities concerning for encephalitis/meningoencephalitis. Cerebrospinal fluid analysis revealed elevated protein, elevated glucose, and increased IgG/albumin ratio, while infectious CSF studies were negative. Autoimmune testing was notable for positive ANA, anti-dsDNA, anti-SSA/SSB, low complement levels, and a positive direct antiglobulin test indicating autoimmune hemolytic anemia.<br /><br />Given the neurologic findings plus multiorgan involvement, she was diagnosed with systemic lupus erythematosus with neuropsychiatric involvement (NPSLE). She was initially treated with anticonvulsants, IV dexamethasone, and empiric antibiotics, then improved after pulse-dose steroids and weekly rituximab. Because of worsening renal function, mycophenolate mofetil was started for suspected lupus nephritis. Her course was complicated by pleural and pericardial effusions, hypertension, and aspiration pneumonia. A renal biopsy later confirmed class III lupus nephritis, leading to treatment with belimumab and further clinical improvement.<br /><br />Repeat MRI after four weeks showed near-complete resolution of brain abnormalities, and labs including complement levels and anti-dsDNA improved. She was discharged to rehabilitation on a prednisone taper and mycophenolate.<br /><br />The report emphasizes that status epilepticus can be an unusual presentation of SLE/NPSLE and highlights the importance of early recognition, multidisciplinary care, and timely immunosuppressive therapy to improve outcomes.

Asset Subtitle

Rafia Ali

Meta Tag

Author List Rafia Ali, Randolph Sanchez, Vanessa Castellanos, Young Ju Lee

Category Clinical Vignettes

Concept Neuropsychiatric Systemic Lupus Erythematosus

Concept Status Epilepticus

Concept Seizure

Concept Systemic Lupus Erythematosus

Concept Immunosuppressive Therapy

Distinguished Non-Finalist

Presenter Organization Humc

Presenting Author Rafia Ali

Track Adult

Keywords

systemic lupus erythematosus

neuropsychiatric lupus

status epilepticus

seizure

lupus nephritis

rituximab

mycophenolate mofetil

anti-dsDNA

MRI brain abnormalities

autoimmune hemolytic anemia

Neuropsychiatric Systemic Lupus Erythematosus

Status Epilepticus

Seizure

Systemic Lupus Erythematosus

Immunosuppressive Therapy