title: Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review.
abstract: Weakness, seizures, and encephalopathy have a broad differential diagnosis in patients with systemic lupus erythematosus (SLE). We present a case of a 26-year-old female with a recent diagnosis of SLE who experienced a clinical deterioration with quadriparesis, seizures, and encephalopathy. Her quadriparesis was found to be secondary to biopsy-proven hydroxychloroquine-induced myopathy with concomitant inflammatory myopathy. Her seizures and encephalopathy were suspected to be multifactorial in the setting of sepsis and critical illness with possible contributions from neuropsychiatric manifestations of SLE and macrophage activation syndrome. She experienced a dramatic clinical recovery with discontinuation of hydroxychloroquine, treatment of lupus disease activity with mycophenolate mofetil and prednisone, and antibiotic treatment for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. This case-based review provides a systematic approach to quadriparesis, seizures, and encephalopathy in patients with SLE and an evidence-based discussion of antimalarial myopathy, which is of critical importance given the widespread use of antimalarial medications for rheumatologic diseases.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0633, 533 Parnassus Avenue, San Francisco, CA, 94143, USA. kashif.jafri@ucsf.edu.
authors.forename: Kashif
authors.identifier: http://orcid.org/0000-0002-9717-7827
authors.initials: K
authors.lastname: Jafri
authors.affiliation: Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Hengameh
authors.initials: H
authors.lastname: Zahed
authors.affiliation: Department of Medicine, Division of Rheumatology, University of California, San Francisco, VA Medical Center, 4150 Clement Street, 111R, San Francisco, CA, 94121, USA.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Wysham
authors.affiliation: Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0633, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Patterson
authors.affiliation: Department of Pathology, Division of Neuropathology, University of California, San Francisco, 505 Parnassus Avenue, Rm. M-580, San Francisco, CA, 94143, USA.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Nolan
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Bucknor
authors.affiliation: Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0633, 533 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Chaganti
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009135:Muscular Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D052097:Quadriceps Muscle / Q000473:pathology / Q000648:ultrastructure; D011782:Quadriplegia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D012640:Seizures / Q000209:etiology
chemical_list: D000962:Antimalarials; D006886:Hydroxychloroquine
keywords: Adverse medication effect; Myopathy; Seizures; Systemic lupus erythematosus