Systemic lupus erythematosus presenting as subacute delirium in an 82-year-old woman

OBJECTIVES: To describe an older patient with delirium attributed to system ic lupus erythematosus (SLE) and to review the literature on neuropsychiatr ic manifestations of SLE in older people. DESIGN: Case report and literature review. MEDLINE search using terms syste mic lupus erythematosus, neurologic, psychiatric, neuropsychiatric, autoant ibodies antinuclear antibody (ANA), antiphospholipid, anticardiolipin, anti -double stranded deoxyribonucleic acid (anti-dsDNA), anti-Smith), and elder ly. Additional articles obtained from hand-searched references and through experts. SETTING: Hospital (case report). PARTICIPANTS: Case report and literature cases. MEASUREMENTS: None. RESULTS: SLE, is increasingly diagnosed in older adults. Onset is insidious and diagnosis is delayed because of a different clinical spectrum and immu nological profile than in younger adults. Autoantibodies have an important role in the pathogenesis of neuropsychiatric manifestations, while vasculit is is less common. Aggressive immunosuppressive therapy is typically indica ted, although recent case reports suggest that lower doses may suffice. The American College of Rheumatology 1982 revised criteria maybe inadequate to diagnose neuropsychiatric lupus in older persons. CONCLUSION: Neuropsychiatric symptoms can be prominent in older people, pre senting features of SLE. This case illustrates the lowest dose of corticost eroids shown to be effective in an older patient with delirium due to SLE.