Systemic lupus erythematosus (SLE) can present with thrombotic microangiopathy (TMA), and differentiating this from thrombotic thrombocytopenic purpura can be a challenging task. Though thrombotic–thrombocytopenic purpura (TTP) is a type of TMA demonstrating a severely reduced activity of VWF, cleaving protease ADAMTS 13 can differentiate it from other causes of TMA. Association of TTP-like TMA and catatonia in lupus is not described in literature. Neuropsychiatric lupus presenting as catatonia is uncommon. Here we describe a 41-year-old female who was presented with TTP-like TMA and catatonic symptoms, which improved with plasma-exchange, benzodiazepines, and immunosuppression.
Blum D, Blake G. Lupus-associated thrombotic thrombocytopenic purpura-like microangiopathy. World J Nephrol 2015 Nov 6;4(5): 528–531. DOI: 10.5527/wjn.v4.i5.528.
Chaudhury D, Qureshi A, Prasad S, et al. Catatonia - An unusual presenting clinical manifestation of systemic lupus erythematosus. Reumatol Clin 2017 Jul-Aug;13(4):224–226. DOI: 10.1016/j.reuma.2016.03.013.
Ainiala H, Loukkola J, Peltola J, et al. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 2001;57: 496–500. DOI: 10.1212/WNL.57.3.496.
Mak A, Ho RC, Lau CS, et al. Clinical implications of neuropsychiatric SLE. Adv Psychiatr Treat 2009;15:451–458. DOI: 10.1192/apt.bp.108.005785.
Grover S, Parakh P, Sharma A, et al. Catatonia in systemic lupus erythematosus: a case report and review of literature. Lupus 2013 May;22(6):634–638. DOI: 10.1177/0961203313486951.
Grover S, Singh A, Sarkar S, et al. SLE presenting with catatonia in an adolescent girl. J Pediatr Neurosci 2013 Sep;8(3):262–263. DOI: 10.4103/1817-1745.123715.
Pustilnik S, Trutia A. Catatonia as the presenting symptom in systemic lupus erythematosus. J Psychiatr Pract 2011;17:217–221. DOI: 10.1097/01.pra.0000398417.97609.2e.
Fink M, Taylor MA. Catatonia: A Clinician's Guide to Diagnosis and Treatment. New York, NY: Cambridge University Press; 2003.
Wang HY, Huang TL. Benzodiazepines in catatonia associated with systemic lupus erythematosus. Psychiatry Clin Neurosci 2006;60: 768–770. DOI: 10.1111/j.1440-1819.2006.01595.x.
Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc 2006;81:1361–1367. DOI: 10.4065/81.10.1361.
Fayyaz A, Igoe A, Kurien BT, et al. Haematological manifestations of lupus. Lupus Sci Med 2015 Mar 3;2(1):e000078. DOI: 10.1136/lupus-2014-000078.
Abu-Hishmeh M, Sattar A, Zarlasht F, et al. Systemic Lupus Erythematosus Presenting as Refractory Thrombotic Thrombocytopenic Purpura: A Diagnostic and Management Challenge. A Case Report and Concise Review of the Literature. Am J Case Rep 2016 Oct 25;17:782–787. DOI: 10.12659/AJCR.898955.
Stricker RB. Two enigmas in one patient: TTP and SLE. South Med J 1995 Jul;88(7):795. DOI: 10.1097/00007611-199507000-00027.
Pattanashetti N, Anakutti H, Ramachandran R, et al. Effect of Thrombotic Microangiopathy on Clinical Outcomes in Indian Patients With Lupus Nephritis. Kidney Int Rep 2017 Apr 27;2(5):844–849. DOI: 10.1016/j.ekir.2017.04.008.