Neuro lupus Revealed by an Acute Psychiatric Episode in a 14 Year Old Adolescent Girl: A Case Report

Introduction: Neuro lupus, the neuropsychiatric form of systemic lupus erythematosus (SLE), may present in an atypical even inaugural manner, particularly in children and adolescents. Although relatively rare compared with the adult form, juvenile lupus often exhibits increased severity and more rapidly progressive clinical manifestations, including its neuropsychiatric component. The objective of this work is to emphasize the importance of suspecting, identifying, and managing neuro lupus early in pediatric patients presenting with unexplained mental disorders, in order to prevent any diagnostic delay that could affect prognosis. Case presentation: We report the case of a 14 year old Moroccan adolescent girl, Hasna B., admitted to the pediatric emergency department for psychomotor agitation. Her early development was globally delayed, and for one year she had exhibited progressive social withdrawal, mistrust toward her family, and verbal hallucinations, all of which led to discontinuation of schooling. Despite this deterioration, no management had been instituted. The psychiatric examination objectified a catatonic syndrome associated with a hallucinatory syndrome, while her history notably included inflammatory arthralgias, an untreated femoral fracture, arterial hypertension of indeterminate etiology, and a family history of deafness. Additional investigations demonstrated positive antinuclear antibodies, cerebellar atrophy on magnetic resonance imaging, global cerebral dysfunction on electroencephalogram, a sensorimotor polyneuropathy on electroneuromyogram, and bilateral papilledema on ophthalmologic examination. In view of these results and the clinical picture, the diagnosis of juvenile neuro lupus was retained. Discussion: Juvenile lupus may account for up to twenty percent of all lupus cases. Compared with adults, it is characterized by often more severe involvement, a female predominance, and an increased risk of neurologic or psychiatric involvement (neur