Systemic lupus erythematosus, antiphospholipid antibodies, chorea, and oral contraceptives.

Abstract

The authors describe a case of a 21-year-old woman with systemic lupus erythematosus and high titers of antiphospholpid antibodies who developed chorea soon after she began oral contraceptive (OC) use. Chorea is an infrequently documented central nervous system complication of OC use. Systemic lupus erythematosus had been diagnosed in 1980 and the patient was treated with high doses of prednisone. In 1984 the patient complained of fidgeting of her left hand; she related this to the commencement of OC use (Binovum) 3 months previously. The chorea markedly improved following discontinuation of OC use. The occurrence of chorea in OC users has been reported with increasing frequency since 1966 when the first such case was described. Chorea commonly occurs in patients who have had previous episodes of chorea either in association with streptococcal infection or pregnancy and tends to emerge 1-4 months after the start of OC use. Both high and low-dose OCs have produced chorea; however it has been suggested that estrogens alone are the causative agent. Although antithrombin III levels are lowered in most OC users this has not been the pattern among lupus patients. The patient in this case had high levels of anticardiolipin antibodies for several years before taking OCs. Such high levels in patients with systemic lupus erythematosus may represent an additional risk factor for the development of thrombotic complications in OC users.