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Systemic lupus erythematosus - CNS vasculitis

Case contributed by Devanshi Dharaiya
Diagnosis probable

Presentation

Altered mental status and seizures.

Patient Data

Age: 45 years
Gender: Female

Axial FLAIR showing multiple patchy areas of hyperintensity at grey-white junction, likely ischemic in origin suggestive of CNS vasculitis.

Case Discussion

Rheumatological markers for systemic lupus erythematosus (SLE) were positive and indicated active disease.

Diagnosis of CNS vasculitis was made clinically and the risk of brain biopsy vs trial of steroids was weighed. The patient decided to trial of steroids and immunosuppressants.

After 2 months, the patient showed dramatic improvement clinically and on imaging after treatment with steroids and rituximab.

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