Mania as an Initial Feature of Systemic Lupus Erythematosus: A Case Report

以躁症為初發表現的全身性紅斑狼瘡：個案報告

葉宏明(Horng-Ming Yeh) ； 胡崇元(Sou-Yen Hu)

《內科學誌》 18卷5期 (2007/10) Pp. 283-286

https://doi.org/10.6314/JIMT.2007.18(5).08

摘要

全身性紅斑狼瘡是慢性的自體免疫疾病，以精神症狀為初發表現的全身性紅斑狼瘡個案相當少見。本文報告一位42歲女性，沒有精神疾病或自體免疫疾病家族史，在29歲時出現聽幻覺、失眠、情緒不穩、多話等症狀，而被診斷為變極性情感性精神病。在十二年的追蹤觀察中，曾因為躁症發作住院三次。去年十一月因情緒高亢，活動量大，自大，意念飛躍等躁症症狀來求診而住進急性精神科病房。住院時發現有雙頰紅疹和光過敏的現象，經過一連串檢查後發現抗核抗體陽性、抗變股DNA抗體陽性，腦電波和電腦斷層檢查並無異常。此病人在躁症出現12年後，因雙頰紅疹、光過敏、精神疾病、抗雙股DNA抗體陽性和抗核抗體陽性診斷為全身性紅斑狼瘡。經過治療後第補三體回升，精神症狀改善，病人繼續在門診追蹤中。

並列摘要

The initial feature of psychiatric symptoms in patients with systemic lupus erythematosus (SLE) is rare and difficult in diagnosis. This 42 y/o female is a victim of bipolar I disorder, she has no family history of psychosis or autoimmune disease. At the age of 29, she began to complain of psychiatric symptoms. Poor sleep, auditory hallucination, irritable mood, racing thought, hyper-talkative were the major symptoms. She came to our psychiatric clinic for help and was diagnosed as bipolar I disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. During the 12 years of follow-up, flare up of symptoms was not frequent; she was admitted to acute psychiatric ward for 3 times due to manic episodes. Last Nov. she suffered from acute manic symptoms for 1 week. She came to our psychiatric clinic for help and was admitted. Malar rash was noted and series of examinations were arranged. EEG and contrasted Brain CT scan were negative. Because of the positivity of antinuclear antibody and anti-double strand DNA, the existence of psychiatric symptoms, photosensitivity, and malar rash, she was diagnosed as SLE, 12 years after manic present. Prednisolone 5mg bid was started first and adjusted to 7.5 mg qd after discharge with plaquenil 200 mg bid, improvement in the mental state and activity index of SLE of this patient have been observed.

並列關鍵字

Systemic lupus erythematosus SLE ； Mania