[A case of systemic lupus erythematosus diagnosed 7 years after epileptic seizure and developed chorea during prednisolone treatment].
An 18-year-old female with 7 years' history of epilepsy was admitted for developing malar rash. She had been treated with hydantoin for 7 years. Laboratory examinations revealed leukopenia and high titer of anti-dsDNA antibodies. Renal biopsy also showed diffuse segmental mesangial proliferative glomerulonephritis. A diagnosis of systemic lupus erythematosus (SLE) was made, and she received 40 mg of prednisolone daily. At follow up 4 months later since her first visit, she developed choreiform movements involving the right upper and lower limbs, despite no signs of increase in her disease activity. Neither biological false positive testing for syphilis nor the lupus anticoagulant (LAC) was detected. MRI demonstrated no signal abnormalities in the brain. Administration of haloperidol was started and the choreiform movements were decreased. Anticonvulsants are associated with drug-induced lupus. On the other hand, seizure is known to be one of the first manifestations of SLE. In drug-induced lupus, positive testing for anti-dsDNA, anti-Sm antibodies, hypocomplementemia and renal involvement are not a frequent as in SLE. In this case, laboratory findings showed high titer of anti-dsDNA antibodies, positive testing for antihistone, anti-SSA, anti-Ki antibodies, and hypocomplementemia. And mesangial proliferative glomerulonephritis was detected. So we diagnosed her as SLE and suggested that epileptic seizure developed 7 years ago had been the first manifestations of SLE. Neurologic complications of SLE are common, but chorea has been rarely reported. Since it is known that LAC is associated with thrombosis, it has been suggested that small infarctions in the basal ganglia may play a part in the pathogenesis of chorea in SLE. In this case, the LAC was negative and MRI showed no detectable abnormalities. As a result another mechanism may be attributed to chorea in this case.