title: Depression and seizures as the main neuropsychiatric manifestation of mixed connective tissue disorder.
abstract: A 38 years female presented with arthralgia, dyspnoea, progressive proximal muscle weakness, seizures, weight loss, dysphagia, alopecia, and dryness of the eyes and mouth with tightening of the skin. Psychiatric evaluation revealed major depression. She had oral ulcers, tightening of the skin of the hands with restricted mouth opening, and proximal muscle weakness. Mixed connective tissue disorder (MCTD) with predominant polymyositis and neuropsychiatric manifestations was diagnosed as the patient had anti-RNP positive with significantly raised muscle enzymes. This case is unique because major depression in MCTD is rarely documented, severe polymyositis is a rarity and ANA was negative but characteristic anti-RNP antibody was positive.
authors.affiliation: Department of General Medicine, Federal Government Polyclinic Hospital, Islamabad.
authors.forename: Ismaa Ghazanfar
authors.initials: IG
authors.lastname: Kiani
authors.affiliation: Department of General Medicine, Federal Government Polyclinic Hospital, Islamabad.
authors.forename: Safina Hameed
authors.initials: SH
authors.lastname: Qureshi
authors.affiliation: Department of Internal Medicine, Federal Government Polyclinic Hospital, Islamabad.
authors.forename: Faridullah
authors.initials: F
authors.lastname: Shah
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D000927:Anticonvulsants / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage; D015283:Citalopram / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D004576:Electromyography; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D008947:Mixed Connective Tissue Disease / Q000188:drug therapy / Q000473:pathology* / Q000523:psychology; D017285:Polymyositis / Q000188:drug therapy / Q000473:pathology*; D012640:Seizures / Q000209:etiology*; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000974:Antibodies, Antinuclear; D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D007166:Immunosuppressive Agents; D015283:Citalopram; D014635:Valproic Acid; D001379:Azathioprine; D008775:Methylprednisolone