Resident SUNY Downstate Health Sciences University New York city, New York, United States
Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that can affect various organs in the body with a diverse clinical presentation. SLE can affect the central nervous system and may present in ways that mimic a psychiatric illness. While psychiatric presentations are common in adults with SLE, there is a scarcity of literature in children. Objective: Case 1: 18-year-old female presented with weeks of poor appetite, dissociative symptoms, paranoid delusions, suicidal ideation, and catatonia. After anti-psychotic medications remained ineffective, a pediatric consult prompted a search for an underlying medical illness that resulted in a SLE diagnosis.
Case 2: 17-year-old female admitted for depression and suspected eating disorder with weight loss of more than 20% from baseline. She was asthenic, pale with a faint rash over her hands. She had anemia, leukopenia, low albumin and transaminitis. After a 2-week hospitalization with no gain in weight despite counselling and nutritional interventions, a search for a systemic cause revealed a diagnosis of SLE.
Case 3: 17-year-old female presented with 2 weeks of periorbital, pedal, and hand edema. Past history was significant for suicidal and self-harm attempts over 2 years. Proteinuria on lab work prompted a lupus work-up that was positive. Design/Methods: - Results: Psychiatric symptoms have been reported in children with SLE from cognitive impairment, behavioral disturbances, depression, and anxiety to psychosis. These may precede the onset of disease manifestations, by months to years, leading to misdiagnosis or delayed recognition. Diagnosing psychiatric manifestations in pediatric SLE can be challenging due to their overlapping symptoms with other psychiatric disorders. The chronology of psychiatric symptoms in pediatric SLE remains unclear. The management of psychiatric symptoms involves a multidisciplinary approach. Treatment strategies may include medications, psychoeducation, cognitive-behavioral therapy, and psychosocial support for the child and their family. Additionally, adequate control of systemic lupus activity is essential to minimize the impact of psychiatric symptoms.
Conclusion(s): Psychiatric manifestations are not uncommon in children with SLE. Patients who present with symptoms of depression, psychosis, mood and eating disorders, or other psychiatric manifestations should be further investigated to ensure optimal outcomes for these children. Additionally, further research is warranted to elucidate the underlying mechanisms and develop targeted interventions for psychiatric manifestations in pediatric SLE.
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