Rare presentation of systemic lupus erythematosus (SLE): a case report

We present a 17-year-old girl, a known case of SLE diagnosed 6 months back, who presented with acute urinary retention. She had delayed development of secondary sexual characters. Investigations revealed megaloblastic changes with low serum cobalamin and folic acid levels, 1.8 mean corpuscular volume (MCV) and 3 for cobalamin and MCV, and serum cobalamin by chemiluminescence. The rare case report of pathology revealed megalo normoblastic changes. She had a positive ANA by immunofluorescence and high titres of anti-dsDNA, high levels of C3, low levels of C4, and positive anti-Ro antibody. Increased peripheral blood cytopenia. Sensory perception showed decreased appreciation of touch at the level of the umbilicus. She had transverse myelitis and neurogenic bowel and bladder with bowel incontinence, which was managed with digital evacuation as fail-related artery was the cause of urinary retention due to neurogenic bladder. Her Doppler was normal.

This case is very unique because of its clinical presentation. Although neurologic presentations are not extremely rare in SLE, they are usually in the form of seizures, strokes, neuropsychiatric SLE (NPSLE), or transverse myelitis. However, only a few large series have focused on this aspect of SLE. A few case reports described patients with SLE who presented with severe chronic constipation; however, this phenomenon is not associated with the presence of antiphospholipid antibodies (APAs). It is not clear in cases of SLE whether slow gastrointestinal (GI) motility is due to poor nutrition, systemic low-grade chronic inflammation, steroid use, anti-inflammatory and non-steroidal medications, or the neurological complications together. Propulsive contractions disappear and segmentation decreases if there is a chronic myelopathy lesion above the fourth lumbar enlarged ventricle, while the normal bowel function and defecation mechanism remain intact. Whenever it also results in incontinence, manual evacuation from the level of the anorectal junction may become necessary.

Keywords: Systemic Lupus Erythematosus; Hemoptysis; Antinuclear antibody (ANA)

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