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Systemic lupus erythematosus presenting with quadriparesis: A case of misdiagnosis

Systemic lupus erythematosus (SLE) is a multisystem disorder affecting almost every organ system. It is a chronic inflammatory disorder occurring almost exclusively in women. The presentation and course are highly variable ranging from indolent to fulminant. Older literature considers SLE to be rare in the African. Recently, however, it has been shown that SLE is seen in a significant number of Africans, but the low incidence stems from underdiagnosis. We present one such woman who presented with quadriparesis having been misdiagnosed initially when she had just the classical triad. Diagnosis was clinical and also confirmed with immunological tests. This patient is a 32-year-old female, with a 9 month history of persistent, progressive joint pains involving the ankles and feet. Six months later she noticed bilateral leg swelling and gradual involvement of the upper limbs. She was referred to the Neurology unit on account of inability to walk and recurrent fever. She had associated generalized hyper-pigmented raised patches on the trunk with tender edematous hand and feet joints and high blood pressure. A diagnosis of SLE was made after the initial review. Investigations revealed the proteinuria, thrombocytopenia, and positive anti-nuclear antibodies and double-stranded DNA autoantibodies. Thereafter, a definitive diagnosis of SLE was made. She was commenced on Prednisolone which controlled the flare. After one month of admission, the Prednisolone was tapered down. She had standing re-education with physiotherapy. She had started walking before discharge. SLE is also seen in African women living in Africa. The protean manifestations make diagnosis difficult; however, the availability of the immunological tests in our practice has made the diagnosis easier. There yet remains a need for a high index of suspicion. The classical triad of fever, joint pain and rash in a woman of childbearing age should prompt investigation and diagnosis of SLE.