Abstract
Although central nervous system involvement is an important manifestation of systemic lupus erythematosus (SLE), chorea is a relatively uncommon complication. A strong association between chorea and the presence of antiphospholipid antibodies (aPLs) has been reported in patients with SLE, lupus-like disease, or primary antiphospholipid syndrome. We describe a patient with lupus nephritis and cerebral infarction, who subsequently developed recurrent hemichorea associated with increased aPLs levels. A 7-year-old boy suffered from lupus nephritis and a left middle cerebral artery infarction associated with aPLs. He subsequently experienced two episodes of right hemichorea associated with increased aPLs levels without any evidence of further neurological lesions by brain computed tomography or magnetic resonance imaging. The previous left cerebral artery infarction might have increased the susceptibility of the left basal ganglia to the effects of aPLs that contributed to the development of the right hemichorea in this patient.
References
Steinlin MI, Blaser SI, Gilday DL, Eddy AA, Logan WJ, Laxer RM, Silverman ED (1995) Neurologic manifestations of pediatric systemic lupus erythematosus. Pediatr Neurol 13:191–197
Asherson RA, Derksen RHWM, Harris EN, Bouma BN, Gharavi AE, Kater L, Hughes GRV (1987) Chorea in systemic lupus erythematosus and “lupus-like” disease: association with antiphospholipid antibodies. Semin Arthritis Rheum 16:253–259
Cervera RC, Asherson RA, Font J, Tikly M, Pallarés L, Chamorro A, Ingelmo M (1997) Chorea in the antiphospholipid syndrome. Clinical, radiologic, and immunologic characteristics of 50 patients from our clinics and the recent literature. Medicine (Baltimore) 76:203–212
Brey RL, Escalante A (1998) Neurological manifestations of antiphospholipid antibody syndrome. Lupus 7 [Suppl 2]:S67–S74
Vlachoyiannopoulos PG, Dimou G, Siamopoulou-Mavridou A (1991) Chorea as a manifestation of the antiphospholipid syndrome in childhood. Clin Exp Rheumatol 9:303–305
Besbas N, Damarguc I, Ozen S, Aysun S, Saatci U (1994) Association of antiphospholipid antibodies with systemic lupus erythematosus in a child presenting with chorea: a case report. Eur J Pediatr 153:891–893
Angelini L, Zibordi F, Zorzi G, Nardocci N, Caporali R, Ravelli A, Martini A (1996) Neurological disorders, other than stroke, associated with antiphospholipid antibodies in childhood. Neuropediatrics 27:149–153
Janavs JL, Aminoff MJ (1998) Dystonia and chorea in acquired systemic disorders. J Neurol Neurosurg Psychiatry 65:436–445
Kent MN, Alvarez FJ Ng AK, Rote NS (2000) Ultrastructural localization of monoclonal antiphospholipid antibody binding to rat brain. Exp Neurol 163:173–179
Furie R, Ishikawa T, Dhawan V, Eidelberg D (1994) Alternating hemichorea in primary antiphospholipid syndrome: evidence for contralateral striatal hypermetabolism. Neurology 44:2197–2199
Harel L, Zecharia A, Straussberg R, Volovitz B, Amir J (2000) Successful treatment of rheumatic chorea with carbamazepine. Pediatr Neurol 23:147–151
Paus S, Pötzsch B, Risse JH, Klockgether T, Wüllner U (2001) Chorea and antiphospholipid antibodies: treatment with methotrexate. Neurology 56:137–138
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Watanabe, T., Onda, H. Hemichorea with antiphospholipid antibodies in a patient with lupus nephritis. Pediatr Nephrol 19, 451–453 (2004). https://doi.org/10.1007/s00467-003-1388-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-003-1388-6