Recurrent hemichorea in an adolescent with systemic lupus erythematosus and previous ipsilateral cerebral infarction

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is an autoimmune disease known to cause various neurological complications.
• Chorea, characterized by involuntary, rapid, jerky movements, is a recognized but often inconsistently presenting neurological manifestation in SLE.
• Antiphospholipid (aPL) antibodies are frequently implicated in the pathogenesis of neurological disorders associated with SLE, including chorea.

Observation:

• A 15-year-old female with a history of SLE and cerebral infarction presented with recurrent left-sided hemichorea.
• Elevated antiphospholipid antibody levels were detected in the patient.
• Serial brain magnetic resonance imaging (MRI) scans, including perfusion studies, did not reveal acute lesions or explain the asymmetric hemichorea during episodes.

Findings:

• The case demonstrates a discrepancy between clinical presentation (hemichorea) and neuroimaging findings in SLE.
• Recurrent hemichorea in this SLE patient with elevated aPL antibodies occurred without detectable acute cerebral lesions on MRI.
• The pathophysiology of chorea in SLE, particularly its asymmetric manifestation and association with aPL antibodies, remains incompletely understood.

Implications:

• This case underscores the challenges in diagnosing and understanding chorea in SLE patients, especially when neuroimaging is inconclusive.
• Further research into the mechanisms underlying chorea in SLE is crucial for improving diagnostic accuracy and patient prognosis.
• Investigating novel imaging or diagnostic markers may be necessary to elucidate the pathophysiology of movement disorders in SLE.