Diagnostic treatment of dilemma in systemic lupus erythematosus presenting with psychotic symptoms: A case series Dilema diagnóstico y terapéutico en el lupus eritematoso sistémico presentado con síntomas psicóticos: una serie de casos
Reumatologia Clinica, cilt.21, sa.3, 2025 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 21 Sayı: 3
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.reuma.2025.501842
- Dergi Adı: Reumatologia Clinica
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, MEDLINE, DIALNET
- Anahtar Kelimeler: Neuropsychiatric lupus, Lupus psychosis, Autoimmune disease, Psychotic symptoms
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Systemic lupus erythematosus (SLE) is an autoimmune disease causing neuropsychiatric symptoms, including lupus psychosis. This review examines the presentation and treatment resistance of lupus psychosis through a case series and comparison with existing literature. Our case series includes four patients with lupus psychosis. The first two cases showed psychotic symptoms as the primary manifestation of SLE, resistant to antipsychotic treatment. Literature suggests that this resistance may be due to immunological factors, such as anti-ribosomal P protein antibodies, and neurotransmitter alterations. The third case involved psychosis exacerbated by discontinuation of immunosuppressive therapy. The fourth case presented psychosis years before an SLE diagnosis, highlighting diagnostic challenges. MRI and EEG findings were generally nonspecific. Treatments included high-dose corticosteroids, immunosuppressive agents, and antipsychotic medications tailored to individual needs. Lupus psychosis is challenging to diagnose and treat due to its complex pathogenesis and potential for treatment resistance. Our cases highlight the need for considering SLE in patients with treatment-resistant psychosis and the importance of individualized treatment strategies.