Neuropsychiatric systemic lupus erythematosus: a rare case of acute polyneuropathy

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which presents most commonly in middle aged females and affects multiple organ systems. Amongst the many systems involved, the nervous system generally gets affected later in the course of the disease. We report a case of a male patient who developed quadriparesis as the initial presentation of SLE who progressed to lupus nephritis. The patient was started on methylprednisolone, and later planned on IVIg when he did not respond to the initial treatment. Unfortunately, the patient developed diaphragmatic paralysis and succumbed to the illness.

Pheochromocytoma presenting as intra-cerebral hemorrhage in a young male

A male in his late teens presented with sudden onset left-sided hemiparesis and right-sided facial weakness. The patient had a history of persistent pulsatile headache for 1 year with the blurring of vision. He also had a history of diaphoresis and palpitations. The patient was diagnosed as a case of hypertension 1 year back. On examination, Right-sided upper motor neuron type facial palsy was present, and power was 0/5 in the left upper and lower limbs; BP was 220/120 mm Hg and was controlled using prazosin and nifedipine. A non-contrast computed-tomography scan (NCCT) of the brain revealed an intracerebral hemorrhage in the right ganglio-capsular region. Abdominal CT scan findings revealed a right suprarenal mass. 24-hour urinary normetanephrine was elevated, suggesting a diagnosis of pheochromocytoma. The surgical resection of the mass was delayed as the patient had developed Dengue shock syndrome, and he died of multiple organ dysfunction syndrome.