Tremor as a Neuropsychiatric Manifestation of Systemic Lupus Erythematosus: A Case Report and Review of Related Literature

Jao Jarro B. Garcia, Roland Dominic G. Jamora
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Abstract

Movement disorders in neuropsychiatric systemic lupus erythematosus (NPSLE) are rare. Chorea remains the predominant phenomenology whereas tremors are reported as a treatment-related side effect or as a component of another syndrome. However, an isolated tremor is rarely reported as a movement-related NPSLE manifestation. We report a 27-year-old female initially admitted because of a 2-month history of undocumented fever, malaise, anorexia, weight loss, and progressive dyspnea. She was eventually referred to the Neurology service because of tremors. Evaluation revealed postural and intention tremors involving bilateral arms with no signs of parkinsonism, ataxia, or other movement abnormalities. Propranolol 20 mg/day was started and afforded tremor reduction whereas neuroimaging revealed findings suggestive of central nervous system (CNS) vasculitis. She was eventually diagnosed with SLE given the over-all findings of positive anti-nuclear antibody, low complement 3, pericarditis, pleuritis, leukopenia, and hemolytic anemia. Her tremors and CNS vasculitis were also deemed active neuropsychiatric manifestations of her lupus. Plan was to administer methylprednisolone pulse but prior to her first dose, she succumbed to pulmonary embolism. A systematic search of literature yielded four studies reporting 12 NPSLE cases with isolated tremor syndromes. Tremors in lupus likely result from the autoantibody attack of the extrapyramidal system on top of previously described tremor generation mechanisms. NPSLE may rarely present with an isolated tremor syndrome. Although much had been discovered regarding tremor generation pathways, those occurring as a result of systemic conditions may reflect additional mechanisms that have yet to be explored further.

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震颤是系统性红斑狼疮的一种神经精神表现:病例报告和相关文献综述
神经精神系统性红斑狼疮(NPSLE)的运动障碍非常罕见。舞蹈症仍是主要现象,而震颤则被报告为与治疗相关的副作用或其他综合征的组成部分。然而,很少有报道称孤立的震颤是与运动相关的非系统性红斑狼疮表现。我们报告了一名27岁的女性患者,她最初入院是因为2个月的无证发热、乏力、厌食、体重减轻和进行性呼吸困难病史。由于震颤,她最终被转诊至神经内科。评估显示,她双臂出现姿势性和意向性震颤,但没有帕金森病、共济失调或其他运动异常的迹象。开始使用普萘洛尔 20 毫克/天,震颤症状有所缓解,而神经影像学检查结果显示她患有中枢神经系统(CNS)血管炎。鉴于抗核抗体阳性、低补体3、心包炎、胸膜炎、白细胞减少症和溶血性贫血等综合检查结果,她最终被诊断为系统性红斑狼疮。她的震颤和中枢神经系统血管炎也被认为是狼疮的活动性神经精神表现。原计划使用甲基强的松龙脉冲,但在第一次用药前,她因肺栓塞而死亡。通过对文献进行系统检索,发现有四项研究报告了12例患有孤立性震颤综合征的非狼疮患者。狼疮患者的震颤很可能是在之前描述的震颤产生机制基础上,锥体外系受到自身抗体攻击所致。非系统性红斑狼疮很少会出现孤立的震颤综合征。尽管有关震颤产生途径的研究已经取得了很多成果,但由于系统性疾病而出现的震颤可能反映了其他机制,这些机制还有待进一步探索。
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