Atypical Presentation of Systemic Lupus Erythematous with Vasculitic Polyneuropathy

Abstract

A 22-year-old female patient with Systemic Lupus Erythematous (SLE) without any significant history with no comorbidities presented with complaints of acute onset pain and burning sensation in bilateral lower limbs predominantly involving soles and feet with additional history of hair loss and Malar rash. On evaluation her vitals were stable, pedal edema was present, cardiovascular, respiratory, abdominal system revealed no significant abnormality. Neurological examination revealed absent ankle reflexes bilaterally. Plantars were flexor bilaterally, altered sensation and decreased proprioception and joint sensation bilateral lower limbs. She was evaluated for above mentioned complaints and examination findings. Nerve conduction study revealed severe sensory motor polyneuropathy predominantly involving bilateral lower limbs. MRI Brain and whole spine screening were within normal limits. Autoimmune workup was positive for antinuclear antibodies, anti-dsDNA, anti-SmD1, anti-histone, anti RibPO,c-ANCA. Bilateral lower limb arteriovenous color doppler was suggestive of subcutaneous edema over ankle and foot with no DVT. According to SLICC (systemic lupus international collaborating clinic criteria) was diagnosed with SLE. Hence, this is a case of SLE with primary presentation of vasculitic polyneuropathy.