Infantile Systemic Lupus Erythematosus with Cerebral Calcification and Delayed Development: Correspondence

Excerpt

To the Editor: I have read with active interest the article “Infantile Systemic Lupus Erythematosus with Cerebral Calcification and Delayed Development” by Garg et al. published in May 2018 of IJP [1]. Systemic lupus erythematosus (SLE) occurring in the first year of life is extremely rare whereas it commonly affects girls around adolescent age group. SLE being a multisystemic disorder, careful examination of different systems including appropriate laboratory assessment is required for proper evaluation of the patient. The authors have nicely described the skin manifestations including history, physical examination and laboratory evaluation. As an evidence of neurological involvement, the index case had psychomotor delay. In view of this, careful neurological examination could have been helpful. In pediatric SLE (pSLE), commonly it presents with neuropsychiatric (NP) or renal manifestations, both of which are considered to be serious forms of SLE in children. Unfortunately, these serious forms are also seen more commonly in children than adults. NP manifestations in pSLE include cerebrovascular disease, cognitive dysfunction, headache, psychosis, cranial and peripheral nerve palsy, transverse myelitis, movement disorders like chorea, cerebellar ataxia, tremor, hemiballismus etc. The diagnostic tool for NP SLE is cerebrospinal fluid (CSF) study, CT and MRI scan of brain [2]. In the present case CT revealed bilateral symmetrical calcification in the gangliothalamic region. Surprisingly, the patient did not show any other classical clinical features of basal ganglia, Here, MRI brain could have added some more clues towards cause of developmental delay. …