Acute meningoencephalitis in a patient with systemic lupus erythematosus

Abstract

Introduction. Infections in patients with systemic lupus erythematosus (SLE) are a significant factor of morbidity and mortality. Although central nervous system infections, including septic meningitis, are rare in patients with SLE, they can be significant causes of mortality inspite of the prompt and accurate diagnosis and proper management. Case report. We presented a woman with the diagnosis of SLE and diffuse proliferative lupus nephritis. Because of disease activity we introduced cytostatic immunosuppressive therapy, cyclophosphamide and then azathioprine. Meningoencephalitis, staphylococcal sepsis and abscess of the brain, with resulting seizures developed. Conclusion. This case alerts to the need of careful examination of patients with SLE, collection of adequate cultures and evaluation of predisposition towards ifnections, before the introduction of immunosuppressants due to potentially fatal infection.Uvod. Infekcije kod bolesnika sa sistemskim eritemskim lupusom (SEL) znacajan su faktor morbiditeta i mortaliteta. Mada su infekcije centralnog nervnog sistema ukljucujuci septicni meningitis, retke kod bolesnika sa SEL, one mogu biti znacajan uzrok mortaliteta i pored brze dijagnoze i adekvatne terapije. Prikaz bolesnika. Prikazali smo bolesnicu sa SEL kod koje je doslo do razvoja meningoencefalitisa i apscesa mozga pri pokusaju uvodjenja citostatske imunosupresivne terapije ciklofosfamidom, a potom azatioprinom. Kao posledica apscesa ostala je encefalomalacija temporoparijetalnog dela mozga sa posledicnim epi napadima. Zakljucak. Ovaj slucaj ukazuje na potrebu pazljivog pregleda svakog bolesnika sa SEL, kao i procene sklonosti prema infekcijama pre uvodjenja terapije drugim imunosupresivnim agensima (pored glikokortikosteroida), zbog potencijalno fatalnih infekcija koje se kod njih mogu razviti.