Acute Manic Episode and Psychosis as Early Manifestations of Systemic Lupus Erythematosus with Lupus Nephritis: A Case Report

Background: Neurological and psychiatric conditions seen in SLE in the absence of other causes are broadly termed Neuropsychiatric SLE (NPSLE).

Case Presentation: This case report was of a 37-year-old, separated female Banker who presented initially with symptoms of mania with psychosis at the Psychiatry Department. She was initially managed as such but represented again with similar symptoms in addition to fluffy brownish hair with hair loss, and hyper-pigmented patches along the bridge of her nose, glabella, and zygomatic regions, extending to the ears and retro auricular region. Annular hypo-pigmentation, atrophic patches were also observed on the extensor surface of both forearms. She developed fever, and epigastric tenderness with several episodes of vomiting and diarrhea which were initially non-bloody at 48hrs into admission on account of which she was placed on antibiotics. The patient improved significantly after which she discharged herself against medical advice however represented 2 days after with a worsened condition. Proactive management was ensured with some sessions of hemodialysis. An assessment of acute flare of systemic lupus erythematosus SLE, precipitated by sepsis was made and was managed as such. The patient recovered tremendously and was discharged to the clinic.

Conclusion: The need for comprehensive examinations and investigations in this regard to exclude other differentials cannot be jettisoned. In this case, it could be said that the psychiatric symptoms came before the obvious signs of SLE, however, it is still possible to think of these symptoms as early signs of SLE or SLE aggravating an underlying mental disorder.