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Year : 2019  |  Volume : 34  |  Issue : 2  |  Page : 167-168  

The reperfusion of ischemic vasculitis in a patient with neuropsychiatric lupus: A serial single-photon emission computed tomography study


1 Section of Nuclear Medicine, Internal Medicine Department and Post-graduation Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
2 Division of Rheumatology, Internal Medicine Department and Post-graduation Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
3 Section of Magnetic Resonance Imaging, Internal Medicine Department and Post-graduation Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
4 Section of Nuclear Medicine, Internal Medicine Department and Post-graduation Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto; Medical Clinic Departament, Bioengineering Interunits Post-graduation Program, São Carlos School of Engineering (EESC), University of São Paulo, São Carlos, Brazil

Date of Web Publication8-Apr-2019

Correspondence Address:
Dr. Ana Carolina Trevisan
Nuclear Medicine Section of Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_135_18

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   Abstract 


We report a 44-year-old female patient diagnosed with neuropsychiatric systemic lupus erythematosus and probable ischemia secondary to vasculitis in the speech motor region (Broca's area). After corticosteroid treatment, the patient recovered the speech, presented clinical improvement, and SISCOM showed reperfusion of the ischemic area (luxury perfusion).

Keywords: Aphasia, brain single-photon emission computed tomography, neuropsychiatric systemic lupus erythematosus


How to cite this article:
Trevisan AC, Louzada P, Pitella FA, Kato M, Santos AC, Wichert-Ana L. The reperfusion of ischemic vasculitis in a patient with neuropsychiatric lupus: A serial single-photon emission computed tomography study. Indian J Nucl Med 2019;34:167-8

How to cite this URL:
Trevisan AC, Louzada P, Pitella FA, Kato M, Santos AC, Wichert-Ana L. The reperfusion of ischemic vasculitis in a patient with neuropsychiatric lupus: A serial single-photon emission computed tomography study. Indian J Nucl Med [serial online] 2019 [cited 2019 Jun 16];34:167-8. Available from: http://www.ijnm.in/text.asp?2019/34/2/167/255597



We report a female patient diagnosed with systemic lupus erythematosus (SLE). It should be presented with renal impairment, weight loss, and persistent proteinuria. After 2 years of the initial treatment, it should be patient had disease reactivation with neuropsychiatric involvement (neuropsychiatric systemic lupus erythematosus (NPSLE)), presenting hemiparesis on the right, acute confusional state, aphasia, and pancytopenia. Magnetic resonance imaging showed findings of cerebral infarctions in multiple territories but suggesting vasculitis in the left frontal inferior gyrus, Broca's area, responsible for the motor control of speech.[1],[2],[3] 99mTc-ethyl cysteinate dimer Single Photon Emission Computed Tomography (SPECT) showed marked perfusion deficit in the Broca's area during the acute phase. After treatment with corticosteroids, the patient recovered the speech, with clinical improvement, and the SPECT showed increased perfusion increase on Broca's area (luxury perfusion), associated to the right cerebellar diaschisis, which was evidence by SISCOM. NPSLE occurs as an autoimmune inflammatory alteration in the central and peripheral nervous system, with some impacts to the patient, mainly psychoses and cognitive dysfunction.[2],[3] In the present patient, there was a probable ischemia secondary to vasculitis [4] in the speech motor area resulting in aphasia, and that was reversible after reperfusion of the ischemic cerebral parenchyma [Figure 1].
Figure 1: A 44-year-old patient diagnosed with systemic lupus erythematosus. It should be presenting with renal impairment, weight loss and persistent proteinuria. After 2 years of the treatment, the patient had disease reactivation with neuropsychiatric involvement, presenting acute confusional state and aphasia. Magnetic resonance imaging findings cerebral infarctions in multiple territories and vasculitis in the left frontal inferior gyrus. Single photon emission computed tomography showed marked perfusion deficit in the Broca's area. After treatment with corticosteroids, she recovered the speech and increased perfusion on Broca's area evidence by SISCOM

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The patient's brain MRI showing multiple inflammatory lesions: (a, b and d) T1-weighted images with gadolinium showing a breakdown of blood–brain barrier and (c) T2-Fluid-attenuated inversion recovery sequence showing increased signal in both anterior frontal lobes and splenium of corpus callosum [Figure 2].
Figure 2: The patient's brain magnetic resonance imaging showing multiple inflammatory lesions: (a, b and d) T1-weighted images with gadolinium showing breakdown of blood–brain barrier and (c) T2-Fluid-attenuated inversion recovery sequence showing increased signal in both anterior frontal lobes and splenium of corpus callosum

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Al-Obaidi M, Saunders D, Brown S, Ramsden L, Martin N, Moraitis E, et al. Evaluation of magnetic resonance imaging abnormalities in juvenile onset neuropsychiatric systemic lupus erythematosus. Clin Rheumatol 2016;35:2449-56.  Back to cited text no. 1
    
2.
Appenzeller S, Reis F, Costallat LTL, Pérez JA, Saldanha CF, Monticielo OA, et al. Wernicke's encephalopathy mimicking neuropsychiatric symptoms in patients with systemic lupus erythematosus: A report of three cases and literature review. Lupus 2017;26:195-9.  Back to cited text no. 2
    
3.
Zardi EM, Taccone A, Marigliano B, Margiotta DP, Afeltra A. Neuropsychiatric systemic lupus erythematosus: Tools for the diagnosis. Autoimmun Rev 2014;13:831-9.  Back to cited text no. 3
    
4.
Mauro L, Manuela M, Valentina M, Sara C, Chondrogiannis S, Maria DF, et al. Role of brain perfusion SPECT with 99mTc HMPAO in the assessment of response to drug therapy in patients with autoimmune vasculitis: A prospective study. N Am J Med Sci 2015;7:135-42.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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