Not applicable

Posterior Reversible Encephalopathy Syndrome (PRES) is an uncommon presentation of neuropsychiatric systemic lupus erythematosus (NPSLE), occurring in less than 1% of patients with systemic lupus erythematosus (SLE). Common manifestations of NPSLE include seizures, encephalopathy, headache, visual disturbances, and focal neurologic deficits. NPSLE often manifests when SLE is present clinically and serologically.

This is the case of a 52-year-old woman with past medical history of SLE who presented with acute confusion and new onset generalized seizure in the setting of severe hypertension, fever, leukocytosis, and recent COVID-19 infection requiring hospitalization.

The patient was found to have acute thrombocytopenia, acute hemolytic anemia, acute encephalopathy, acute renal insufficiency, and acute heart failure, which led her medical team to the presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP). When it turned out that her workup did not meet diagnostic criteria for TTP and her serologic markers were positive for SLE, it led to the final diagnosis of parainfectious NPSLE in the setting of recent COVID-19 infection. The patient was initially treated with plasmapheresis with minimal improvement. She was then treated with pulse dose steroids, after which she had major clinical improvement.

Literature review revealed a small number of cases of PRES in SLE as well as COVID-induced PRES, but no cases of COVID-induced PRES in SLE. NPSLE is one of the least well-understood manifestations of SLE, does not have a specific test, and can have disabling effects on patients. It is important for physicians of all specialties to recognize the various presentations of NPSLE so that patients can be treated promptly and appropriately.