PMID- 37197115
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230519
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 4
DP  - 2023 Apr
TI  - The Enigma of Autoimmunity: A Case of Subacute Sclerosing Panencephalitis in a 
      Patient Diagnosed With Systemic Lupus Erythematosus.
PG  - e37602
LID - 10.7759/cureus.37602 [doi]
LID - e37602
AB  - Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles 
      characterized by progressive neurological deterioration. The onset usually occurs 
      about seven to 10 years after the measles infection. Aside from an earlier age of 
      measles infection, factors that may influence the susceptibility for its 
      development is unknown. There is a paucity of data regarding the course of SSPE 
      in the presence of concomitant autoimmune conditions such as systemic lupus 
      erythematosus (SLE). We report a case of a 19-year-old female who presented with 
      new onset recurrent generalized tonic-clonic seizures, malar rash, and cutaneous 
      erythematous, maculopapular eruptions. Antinuclear antibodies (ANA) and 
      anti-double stranded DNA (anti-dsDNA) serologic examination yielded positive 
      results favoring the diagnosis of SLE. Further in the course of illness, the 
      patient developed generalized myoclonic jerks and progressive decline in 
      language, cognitive, and motor functions. Subsequent investigation showed an 
      elevated anti-measles antibody titer in the cerebrospinal fluid, and periodic 
      generalized, bilaterally synchronous, and symmetric high voltage slow-wave 
      complexes in the EEG. These findings and the typical evolution of neurologic 
      manifestations fulfilled two major and one minor Dyken's criteria for the 
      diagnosis of SSPE. It is postulated that some autoimmune-mediated responses may 
      contribute to the evolution of SSPE. Autoimmune complexes in SLE induce 
      downregulation of T-cell responses which accelerate the loss of antibodies formed 
      against other diseases such as the measles virus that may lead to increased 
      susceptibility to infection. SSPE is hypothesized to result from the 
      downregulation of host-immune responses which leads to incomplete measles viral 
      clearance. To the best of the authors' knowledge, this is the first published 
      case of SSPE with active SLE.
CI  - Copyright (c) 2023, Pajantoy et al.
FAU - Pajantoy, Al Inde John A
AU  - Pajantoy AIJA
AD  - Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial 
      Medical Center, Quezon City, PHL.
FAU - Dimzon, Lester D
AU  - Dimzon LD
AD  - Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial 
      Medical Center, Quezon City, PHL.
FAU - Camara, Pia Teresa A
AU  - Camara PTA
AD  - Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial 
      Medical Center, Quezon City, PHL.
AD  - Department of Clinical Neurosciences, University of the East Ramon Magsaysay 
      Memorial Medical Center, Quezon City, PHL.
FAU - San Luis, Amado M
AU  - San Luis AM
AD  - Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial 
      Medical Center, Quezon City, PHL.
AD  - Department of Clinical Neurosciences, University of the East Ramon Magsaysay 
      Memorial Medical Center, Quezon City, PHL.
LA  - eng
PT  - Case Reports
DEP - 20230415
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10184722
OTO - NOTNLM
OT  - autoimmune
OT  - dyken's criteria
OT  - encephalitis
OT  - measles
OT  - sle
OT  - sspe
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/05/18 01:07
MHDA- 2023/05/18 01:08
PMCR- 2023/04/15
CRDT- 2023/05/17 19:56
PHST- 2023/04/15 00:00 [accepted]
PHST- 2023/05/18 01:08 [medline]
PHST- 2023/05/18 01:07 [pubmed]
PHST- 2023/05/17 19:56 [entrez]
PHST- 2023/04/15 00:00 [pmc-release]
AID - 10.7759/cureus.37602 [doi]
PST - epublish
SO  - Cureus. 2023 Apr 15;15(4):e37602. doi: 10.7759/cureus.37602. eCollection 2023 
      Apr.