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G451 Juvenile systemic lupus erythematosus(jsle) presenting as idiopathic intracranial hypertension

Background Idiopathic intracranial hypertension(IIH) is a rare but recognised presentation in Juvenile SLE. We describe a child who presented with IIH and was also found to have bilateral thromboembolism. Case presentation 13 year old girl presented with a 6 week history of fatigue, headache, blurred vision, abdominal pain and painful fingers. Examination showed faint malar rash, small joint arthritis and bilateral papilledema. Diagnosis of IIH was confirmed by elevated CSF opening pressure 27 cm H2O.Normal CSF sugar, protein and cells and neurological examination. No radiological evidence of underlying pathology including a normal CT and MR venogram. Laboratory workup revealed normocytic normochromic anaemia (9.9), lymphopenia (0.6), low platelets (110), hypocomplementemia, raised ESR (90), positive antinuclear antibody and positive anti ds DNA. Clinical findings and serological criteria confirmed the diagnosis of Juvenile SLE. She was treated with intravenous pulse methylprednisolone, oral prednisolone acetazolamide and hydroxychloroquine. Headache and papilledema resolved however she was represented 2 weeks later with chest pain and breathlessness but on review of history she admitted to breathlessness going back several weeks, CT pulmonary angiography showed bilateral acute pulmonary embolism. Although she had thromboembolism her anticardiolipin, lupus anticoagulant, Beta 2 glycoprotein 1 antibodies were negative. Diagnosis of antiphospholipid syndrome could not be made as it did not fulfil the criteria. Anticoagulation treatment was commenced. She was also given 2 doses of Rituximab. She remains well with clinical improvement as well as improvement in her inflammatory markers. Discussion Our patient illustrates SLE can present with idiopathic intracranial hypertension though very rare and exact pathophysiology remains unclear. Various mechanisms have been proposed including venous thrombosis, immunological or inflammatory but none have been proven. There have been few case reports in paediatric population as first presentation of lupus. Conclusion SLE should be considered as a possible cause in a child presenting with idiopathic intracranial hypertension and a connective tissue screen should be included in the work up. In a known patient with SLE, IIH may be part of the spectrum of neuropsychiatric manifestation and should be considered as a possible cause