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Neuropsychiatric SLE — SCE Rheumatology MCQ

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HardConnective tissue diseasesNeuropsychiatric SLESCE Rheumatology

A 52-year-old woman with SLE has new confusion and seizures. Blood pressure is 132/78 mmHg, MRI brain shows multifocal inflammatory white matter lesions, CSF has lymphocytosis without organisms and C3/C4 are low. Anti-dsDNA is high and antiphospholipid antibodies are negative. What is the most likely diagnosis?

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Correct answer: B — Neuropsychiatric lupus

Seizures, inflammatory CSF, MRI lesions and serological lupus activity support neuropsychiatric SLE after infection and APS-related thrombosis are considered. Multiple sclerosis is a differential, but low complement and high anti-dsDNA point to lupus activity. Management usually requires multidisciplinary assessment and immunosuppression tailored to severity.

Reference: EULAR neuropsychiatric SLE recommendations; BSR SLE guideline