The Case of a Viral Flare
Introduction
The nervous system’s involvement in SLE patients leads to a nonspecific and
heterogeneous group of neuropsychiatric (NP) manifestations. Other etiologies for CNS
involvement must be considered despite the apparent presentation of NPSLE. HSV infection
is more remarkable in an immunocompromised host.
Problem Highlighted: In a Patient with a lupus flare and neurologic presentation, when
should neuropsychiatric syndrome or infectious causes be addressed?
Case
We present a 20-year-old female with a three-day onset of altered
mental status, desquamative pustular lesion in the malar area, and renal impairment that
subsequently had positive ANA and dsDNA, HSV 1 in CSF.
Conclusion
NPSLE should always be a diagnosis of exclusion. Empiric coverage for viral
encephalopathies and other associated causes of CNS manifestations outside SLE must be
considered.
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