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Systemic lupus erythematosus presenting with slurred speech: a case report
Reza Azizi Malamiri1, Negar Dinarvand2, Mohammad Reza Fathi3
1Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Journal of Medical Case Reports
|May 28, 2026
Summary
This case study details a rare presentation of neuropsychiatric systemic lupus erythematosus (NPSLE) in a teenage girl whose primary symptom was isolated dysarthria. Early diagnosis and treatment led to significant clinical improvement, highlighting the importance of recognizing atypical NPSLE symptoms.
Area of Science:
- Rheumatology
- Neurology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical features.
- Neuropsychiatric involvement (NPSLE) is common in SLE, but isolated dysarthria (slurred speech) is exceptionally rare.
- Recognizing atypical NPSLE manifestations is crucial for timely diagnosis and management.
Purpose of the Study:
- To report an unusual case of neuropsychiatric systemic lupus erythematosus (NPSLE) presenting solely with dysarthria.
- To emphasize the importance of considering NPSLE in patients with unexplained neurological symptoms.
- To highlight the effectiveness of prompt immunosuppressive therapy in managing atypical NPSLE.
Main Methods:
- Case presentation of a 14-year-old female with progressive dysarthria, fatigue, arthralgia, and malar rash.
- Comprehensive laboratory workup including autoimmune markers (ANA, anti-dsDNA, anti-histone, antiphospholipid antibodies) and complement levels.
- Brain MRI to evaluate for central nervous system involvement.
- Treatment initiated with intravenous methylprednisolone, followed by cyclophosphamide, oral corticosteroids, and maintenance with mycophenolate mofetil.
Main Results:
- The patient exhibited characteristic SLE autoantibodies, hypocomplementemia, and leukopenia.
- Brain MRI revealed white matter hyperintensities suggestive of vasculitic changes.
- The patient demonstrated marked clinical and laboratory improvement following immunosuppressive therapy.
Conclusions:
- Isolated dysarthria can be a rare yet significant presenting symptom of neuropsychiatric systemic lupus erythematosus (NPSLE).
- Increased clinical awareness of atypical neurological manifestations in SLE is vital for early diagnosis.
- Appropriate and timely treatment of NPSLE can lead to favorable patient outcomes.
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