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INTERNUCLEAR OPHTHALMOPLEGIA AS A NEUROPSYCHIATRIC MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS.
The involvement of the nervous system in systemic lupus erythematosus (SLE) encompasses a wide variety of neurological and psychiatric manifestations. According to the American College of Rheumatology (ACR), there are 19 neuropsychiatric syndromes. Internuclear ophthalmoplegia, although classically associated with multiple sclerosis and cerebral infarction, may represent a manifestation of SLE, even without being mentioned among the syndromes proposed by the ACR.
Female patient, 35 years old, diagnosed with SLE, on treatment with cyclophosphamide for lupus nephritis, started diplopia associated with dizziness. At the physical examination, paresis of the ocular adduction and nystagmus on the right right were observed. A nuclear magnetic resonance of the brain was performed with a hypersignal in a medial longitudinal fasciculus (picture). A normal brain angiotomography was obtained. Cerebrospinal fluid without alterations. Non-reactive antiphospholipid antibodies. Interpreted as a neuropsychiatric manifestation of SLE. Initiated therapy with Methylprednisolone 1 gram, intravenous, for three days, with resolution of symptoms. The therapy for lupus nephritis was mainted with Cyclophosphamide.
The objective of this case is to alert the rheumatologist about the wide range of neuropsychiatric presentations attributed to SLE, many of them more unusual and not included in the traditional classification.
Systemic Lupus Erythematosus
Vani Abreu Souza Filho, Aloma Guinami Scabora, Camille Constanzo Codogno Postigo Castro, Marília Bulhões Calheiros, Yves Glauber Silva Santos, Marcondes Cavalcante França Júnior, Alisson Aliel Vigano Pugliesi, Simone Appenzeller, Lilian Tereza Lavras Costallat