Adult-onset Seizures as the First Manifestation of Anti-dsDNA Negative Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a quintessential autoimmune disease once thought to be rare among Africans. Neuropsychiatric manifestations of SLE range from headaches, mood/behavioral disorders, to seizures. There are documented reports of seizures accompanying the diagnosis of SLE, with varying prevalence according to specific regions. However, seizures rarely precede the diagnosis of SLE. We present a case report of a 19-year-old African woman with adult-onset seizures preceding an overt diagnosis of negative anti-dsDNA SLE. A preceding short course of anti-malarial and carbamazepine prompted early consideration of drug-induced lupus erythematosus. However, the clinical features of SLE progressed and persisted despite their discontinuation. Among high-risk groups, it is important to recognize SLE as a potential cause of adult-onset seizures. In the absence of clear offending agents, metabolic or structural disease, baseline antinuclear antibody may be imperative in the diagnostic workup of such patients.