title: Wernicke's encephalopathy mimicking neuropsychiatric symptoms in patients with systemic lupus erythematosus: a report of three cases and literature review.
abstract: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves many organs and systems. Nervous system involvement in SLE encompasses neurological and psychiatric disorders, and remains a diagnostic and therapeutic challenge. Wernicke's encephalopathy (WE) is a neurological disorder that occurs as a consequence of thiamine deficiency, and its clinical presentation resembles the neuropsychiatric events attributed to SLE (NPSLE). Differentiation between these two entities is crucial because their treatment differs greatly and can change prognosis. We describe three cases of patients with SLE who presented with initial clinical findings suggestive of NPSLE that, at the end of a thorough clinical investigation, were actually found to represent WE. In all of these cases, treatment with thiamine resulted in significant improvement. WE should be considered as a differential diagnosis in SLE patients with neuropsychiatric signs and symptoms, especially when risk factors for thiamine deficiency are present.
authors.affiliation: 1 Rheumatology Department, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Appenzeller
authors.affiliation: 2 Radiology Department, Faculdade de Ciências Médicas, UNICAMP, São Paulo, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Reis
authors.affiliation: 1 Rheumatology Department, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: L T Lavras
authors.initials: LTL
authors.lastname: Costallat
authors.affiliation: 3 Division of Neuroradiology, Department of Radiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
authors.forename: J Adams
authors.initials: JA
authors.lastname: Pérez
authors.affiliation: 4 Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Brazil.
authors.forename: C F
authors.initials: CF
authors.lastname: Saldanha
authors.affiliation: 4 Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Brazil.
authors.forename: O A
authors.initials: OA
authors.lastname: Monticielo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D011237:Predictive Value of Tests; D013831:Thiamine / Q000627:therapeutic use; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use; D014899:Wernicke Encephalopathy / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000523:psychology
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine
keywords: Wernicke’s encephalopathy; neuropsychiatric lupus; systemic lupus erythematosus