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After the initial evaluation, she was started on Haloperidol 0.25mg thrice daily to manage the disabling movement disorder.

The bicytopenia revealed in the laboratory test results led to further workup in the line of an autoimmune disorder which showed an elevated anti-nuclear antibody (ANA) titre of 1:640 (Normal Range(NR) histone antibodies with hypocomplementemia- low C3 and C4 ,C3 39 mg/dL (NR 83-193) and C4 11.5 mg/dL (NR 15-57). Urinalysis, thyroid function test, electrocardiogram and chest x-ray were normal. Echocardiography showed normal mitral leaflets with trace aortic and mitral regurgitation. MRI brain was performed which showed a few T2 flair, high signal punctate foci in bilateral frontal lobes i.e. nonspecific demyelinating foci. Further investigation showed positive anticardiolipin IgG and antibeta 2 glycoprotein IgG antibody in the titres of 418 U/ml and 312U/ml respectively.

After having all the available investigation results, we scored her on the EULAR 2019 classification criteria for SLE.¹With features of neurological involvement (chorea), leukopenia, low C3, positive anti-dsDNA and antiphospholipid antibodies, the patient scored 14 in the EULAR 2019 classification criteria.\sout¹The patient was then diagnosed as Neuropsychiatric SLE and was started on hydroxychloroquine, azathioprine and prednisolone.Aspirin was added to her treatment and was planned for repeat antiphospholipid antibody titres after 12 weeks. As the choreiform movements gradually decreased and ceased after the first few days of hospitalization, haloperidol was tapered off.