Generalized chorea as the first presentation of systemic lupus erythematosus: case report and review of literature

Submit Manuscript | http://medcraveonline.com with mobility. Otherwise she did not have any systemic complaints. Had no history of a recent infectious illness and did not use any medication. Her past and family history was unremarkable. On examination, she was alert, fully oriented with intact cognitive functions. The movements were noted as involuntary, rapid and purposeless generalized movements. She could not control it and had difficulty stabilizing her head. Auscultation revealed pansystolic murmur over the apex. She had no skin lesion, joint tenderness or swelling. Blood investigations showed normochromic normocytic anemia with thrombocytopenia (Hb: 8g/dl, MCV: 80 fl, WBCs: 4.5×109 Platelets: 84×109). Had normal renal and liver functions. Coombs test was positive, ANA and anti-dsDNA Abs were positive. Furthermore her cardiolipin IgG was positive (36.9 U/ml) and urine analysis shows hematuria (20-30/HPF) and proteinuria (100 mg/dl). Brain MRI demonstrated multiple bilateral old and recent ischemic lesions (Figure 1). Echocardiography show mildly thickened mitral valve with prolapsed of anterior segments of mitral leaflet & moderate mitral regurgitation.