title: Diffuse leukoencephalopathy and subacute parkinsonism as an early manifestation of systemic lupus erythematosus.
abstract: Parkinsonism in SLE is rare. Diffuse leukoencephalopathy is equally uncommon and is associated with a poor prognosis. We present a single case of a 50-year-old Filipino man who presented with a generalized discoid rash after starting lisinopril. The rash persisted despite discontinuation of lisinopril, and over the next three months, he developed rapidly progressive parkinsonism. Brain MRI showed symmetric confluent T2-hyperintensities involving the white matter and basal ganglia. Four of the 11 American College of Rheumatology criteria for the classification of SLE were met. A rheumatologist made a diagnosis of SLE with cutaneous and central nervous system involvement. Significant neurologic and radiologic improvement occurred following treatment with IV steroids followed by a prolonged taper. This report highlights a case of subacute parkinsonism with a diffuse leukoencephalopathy as an early manifestation of SLE which resulted in a good recovery following treatment with only immunosuppressive therapy.
authors.affiliation: Department of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
authors.forename: Gary G
authors.initials: GG
authors.lastname: Tse
authors.affiliation: Straub Clinics and Hospital, Honolulu, HI 96813, USA.
authors.forename: Alberto S
authors.initials: AS
authors.lastname: Santos-Ocampo
authors.affiliation: Department of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
authors.forename: Dominic C
authors.initials: DC
authors.lastname: Chow
authors.affiliation: Department of Neurology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: McMurtray
authors.affiliation: Department of Medicine, University of Hawaii, Honolulu, HI 96813, USA ; Straub Clinics and Hospital, Honolulu, HI 96813, USA.
authors.forename: Beau K
authors.initials: BK
authors.lastname: Nakamoto