Chorea as the initial presentation of oral contraceptive induced systemic lupus erythematosus.

Abstract

Physicians examined an 18 year old Caucasian female with jerky movements (chorea) in all 4 extremities in the emergency room of a Pennsylvania hospital. Other symptoms at the time of presentation included a temperature of 100 degrees Fahrenheit a pulse rate of 120/minute a grade 2/6 systolic murmur at the apex of the heart and along the left sternal border and a diffuse erythematous rash. A tissue thromboplastin test confirmed the presence of a lupus anticoagulant. She had pain and swelling in both hands for 2 days and experienced malaise accompanied by muscle and joint pain for 2 weeks. 8 weeks prior to onset of symptoms she began taking an ethinyl estradiol oral contraceptive (OC) and it was discontinued upon admission. Physicians diagnosed her as having systemic lupus erythematosus (SLE). Initially she orally took 80 mg/day prednisone in 4 divided doses to improve the symptoms but she did not respond therefore physicians asked for hydrocortisone 120 mg intravenously every 6 hours. To control the chorea/ physicians ordered 1 mg/6-8 hours of haloperidol. After 2 days it was discontinued because chorea had stopped. She recovered remarkably and on the 19th day was discharged taking 80 mg of prednisone daily. 9 months after discharge she had no symptoms and was taking only 10 mg of prednisone daily. OC use has been associated with exacerbation or unmasking of SLE. This case study supports evidence for a possible role of OCs in the induction of SLE and its central nervous system complications. Prudence must be practiced when prescribing OCs in women with SLE with known antiphospholipid antibodies and with a combination of these.