An Unwonted Cause of Acute Cerebellar Ataxia in a Young Lady: A Rare Path to Lupus

Neuropsychiatric manifestations are commonly observed in systemic lupus erythematosus (SLE) patients. In particular, neurological involvement is known to be more common in patients with positive anticardiolipin antibodies and lupus anticoagulants. Nevertheless, cerebellar ataxia has rarely been reported, especially as the first clinical manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). Cerebral vascular infarction or ischemia, vasogenic oedema and antibody-mediated cerebral vasculopathy or vasculitic process have been supposed as possible aetiologies of acute cerebellar ataxia related to SLE. We report the clinical and radiological features of a 38 years old diabetic lady who developed a rapidly progressive cerebellar syndrome as first sign of SLE; no other cause explaining her cerebellar ataxia was found. Imaging of brain in this patient revealed prominent cerebellar atrophy. She was treated with initial pulse intravenous methylprednisolone later oral prednisolone and oral mycophenolate mofetil. There was no further progression of her neurological signs after the initiation of therapy. The appearance of a cerebellar syndrome with unknown aetiology with associated features of possible systemic autoimmune dysfunction, should be taken into account in clinical practice for appropriate diagnostic workup in order to provide effective therapeutic options.