Cerebritis as an initial presentation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE), an autoimmune disease with multi-system manifestations, has several clinical presentations varying from mild muco-cutaneous involvement to severe multi-organ involvement. We report the case of an 18-year-old girl who presented generalized tonic clonic fits. She gave a history of generalized headaches, recurrent painless oral ulcers, photosensitivity, joint pains and low-grade intermittent fever. Magnetic resonance imaging (MRI) scan of the brain revealed T2WI/FLAIR hyperintense signals in bilateral frontal, parietal and occipital regions and magnetic resonance angiography of the brain demonstrated mild areas of luminal narrowing in M1 and M2 segments of middle cerebral arteries bilaterally, suggestive of lupus cerebritis. Anti-nuclear antibody (ANA) and Anti-DsDNA antibodies were positive. She was diagnosed as SLE and was prescribed corticosteroids, cyclophosphamide and hydroxychloroquine. This case highlights cerebritis as initial presentation of SLE.