Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder which can present with a variety of neurologic and psychiatric complications. Currently, there are no consensus neuroimaging findings associated with neuropsychiatric SLE.
Case summary: We describe the unusual neuroimaging findings in a patient with SLE and a history of epilepsy who presented to a tertiary care emergency department with features of neuropsychiatric lupus, as well as recent seizures. Magnetic resonance imaging of the brain revealed an isolated lesion with T2 signal hyperintensity and restricted diffusion in the midline splenium of the corpus callosum.
Conclusions: While establishing the precise etiology underlying the clinical and radiographic observations in this case is difficult, several possibilities are discussed, including acute ischemia and epileptic sequelae. The location of the patient's lesion in a region potentially associated with pure psychotic disorders raises the possibility that such a lesion may be sufficient to produce acute behavior changes and psychotic features in certain patients.