Mania as an Initial Feature of Systemic Lupus Erythematosus: A Case Report

Abstract

The initial feature of psychiatric symptoms in patients with systemic lupus erythematosus (SLE) is rare and difficult in diagnosis. This 42 y/o female is a victim of bipolar I disorder, she has no family history of psychosis or autoimmune disease. At the age of 29, she began to complain of psychiatric symptoms. Poor sleep, auditory hallucination, irritable mood, racing thought, hyper-talkative were the major symptoms. She came to our psychiatric clinic for help and was diagnosed as bipolar I disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. During the 12 years of follow-up, flare up of symptoms was not frequent; she was admitted to acute psychiatric ward for 3 times due to manic episodes. Last Nov. she suffered from acute manic symptoms for 1 week. She came to our psychiatric clinic for help and was admitted. Malar rash was noted and series of examinations were arranged. EEG and contrasted Brain CT scan were negative. Because of the positivity of antinuclear antibody and anti-double strand DNA, the existence of psychiatric symptoms, photosensitivity, and malar rash, she was diagnosed as SLE, 12 years after manic present. Prednisolone 5mg bid was started first and adjusted to 7.5 mg qd after discharge with plaquenil 200 mg bid, improvement in the mental state and activity index of SLE of this patient have been observed.