jabbrv-ltwa-all.ldf
jabbrv-ltwa-en.ldf
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.