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Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review

  • Case Based Review
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Abstract

Weakness, seizures, and encephalopathy have a broad differential diagnosis in patients with systemic lupus erythematosus (SLE). We present a case of a 26-year-old female with a recent diagnosis of SLE who experienced a clinical deterioration with quadriparesis, seizures, and encephalopathy. Her quadriparesis was found to be secondary to biopsy-proven hydroxychloroquine-induced myopathy with concomitant inflammatory myopathy. Her seizures and encephalopathy were suspected to be multifactorial in the setting of sepsis and critical illness with possible contributions from neuropsychiatric manifestations of SLE and macrophage activation syndrome. She experienced a dramatic clinical recovery with discontinuation of hydroxychloroquine, treatment of lupus disease activity with mycophenolate mofetil and prednisone, and antibiotic treatment for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. This case-based review provides a systematic approach to quadriparesis, seizures, and encephalopathy in patients with SLE and an evidence-based discussion of antimalarial myopathy, which is of critical importance given the widespread use of antimalarial medications for rheumatologic diseases.

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Acknowledgements

We thank David W. Wu, MD, the patient’s current primary outpatient rheumatologist, for corroborating details of the patient’s clinical course prior to and following her hospital admission.

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Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, University of California, San Francisco, UCSF Box 0633, 533 Parnassus Avenue, San Francisco, CA, 94143, USA

    Kashif Jafri, Sarah Patterson & R. Krishna Chaganti

  2. Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA

    Hengameh Zahed

  3. Department of Medicine, Division of Rheumatology, University of California, San Francisco, VA Medical Center, 4150 Clement Street, 111R, San Francisco, CA, 94121, USA

    Katherine D. Wysham

  4. Department of Pathology, Division of Neuropathology, University of California, San Francisco, 505 Parnassus Avenue, Rm. M-580, San Francisco, CA, 94143, USA

    Amber L. Nolan

  5. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, San Francisco, CA, 94107, USA

    Matthew D. Bucknor

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  1. Kashif Jafri
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  2. Hengameh Zahed
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Correspondence to Kashif Jafri.

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This study was not funded.

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The authors affirm that the manuscript is an honest, accurate, and transparent account of the case being reported.

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Jafri, K., Zahed, H., Wysham, K.D. et al. Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review. Clin Rheumatol 36, 1437–1444 (2017). https://doi.org/10.1007/s10067-017-3579-8

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  • DOI: https://doi.org/10.1007/s10067-017-3579-8

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