SYSTEMIC LUPUS ERYTHEMATOSIS HERALDING AS NEUROPATHY

Systemic lupus erythematosis is associated with varied neurological manifestations. We are presenting SLE cases heralding with isolated peripheral nerve manifestations.MethodsA case series of 4 patients with rarer neuropathic features. One with AIDP, another with recurrent AIDP, another with severe axonal neuropathy, another with isolated small fibre neuropathy. All thesepatients on evaluation detected to have ANA dsDNA positivity and diagnosed to be SLE. Discussion All the patients had only neuropathic manifestations. Neuropathic manifestations in SLE is seen in 4- 27Pathologically it can be vasculitic or due to autoimmune neuronal damage. The involvement of the peripheral nervous system in SLE is rare. It occurs in three forms, more common is distal symmetric sensory motor axonal poly neuropathy, which usually occurs late in the disease2. Rare cases of a severe motor axonal neuropathy,which usually occurs late in the disease2. Rare cases of a severe motor axonal neuropathy, mononeuritis multiplex and inflammatory demyelinating neuropathy are described in literature and can be the first symptom of SLE2,3,4. Peripheral neuropathy appeared at the onset of the autoimmune disease in 50 of the patients. In the series presented all the four patients had neuroapathy as heralding event. In cases of polyradiculoneuropathy without any possible preceding infectious cause or with recurrence, possibility of autoimmune disease should be ruled out.Comclusion Peripheral nervous system involvement can be isolated and heralding manifestation of SLE manifesting in common or in rarer forms. Autoimmune disease evaluation for early detection should be part in patients with polyradiculoneuropathy not attributable to post infectious cause. These patients need early immunomodulation to prevent disease progression.