Systemic Lupus Erythematosus With Isolated Psychiatric Symptoms and Antinuclear Antibody Detection in the Cerebrospinal Fluid.
Identifieur interne : 000052 ( PubMed/Corpus ); précédent : 000051; suivant : 000053Systemic Lupus Erythematosus With Isolated Psychiatric Symptoms and Antinuclear Antibody Detection in the Cerebrospinal Fluid.
Auteurs : Eva M. Lüngen ; Viktoria Maier ; Nils Venhoff ; Ulrich Salzer ; Rick Dersch ; Benjamin Berger ; Anne N. Riering ; Kathrin Nickel ; Bernd L. Fiebich ; Patrick Sü ; Simon J. Maier ; Karl Egger ; Ludger Tebartz Van Elst ; Dominique EndresSource :
- Frontiers in psychiatry [ 1664-0640 ] ; 2019.
Abstract
Background: Organic psychiatric disorders can be caused by immunological disorders, such as autoimmune encephalitis or systemic lupus erythematosus (SLE). SLE can affect most organs, as well as the central nervous system (CNS). In this paper, we describe a patient with an isolated psychiatric syndrome in the context of SLE and discuss the role of antibody detection in the cerebrospinal fluid (CSF). Case presentation: The 22-year-old German male high school graduate presented with obsessive-compulsive and schizophreniform symptoms. He first experienced obsessive-compulsive symptoms at the age of 14. At the age of 19, his obsessive thoughts, hallucinations, diffuse anxiety, depressed mood, severe dizziness, and suicidal ideation became severe and did not respond to neuroleptic or antidepressant treatment. Due to increased antinuclear antibodies (ANAs) with anti-nucleosome specificity in serum and CSF, complement activation, multiple bilateral white matter lesions, and inflammatory CSF alterations, we classified the complex syndrome as an isolated psychiatric variant of SLE. Immunosuppressive treatment with two times high-dose steroids, methotrexate, and hydroxychloroquine led to a slow but convincing improvement. Conclusion: Some patients with psychiatric syndromes and increased ANA titers may suffer from psychiatric variants of SLE, even if the American College of Rheumatology criteria for SLE are not met. Whether the psychiatric symptoms in our patient represent a prodromal stage with the later manifestation of full-blown SLE or a subtype of SLE with isolated CNS involvement remains unclear. Regardless, early diagnosis and initiation of immunosuppressive treatment are essential steps in preventing further disease progression and organ damage. Intrathecal ANAs with extractable nuclear antigen differentiation may be a more sensitive marker of CNS involvement compared with serum analyses alone.
DOI: 10.3389/fpsyt.2019.00226
PubMed: 31105597
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Systemic Lupus Erythematosus With Isolated Psychiatric Symptoms and Antinuclear Antibody Detection in the Cerebrospinal Fluid.</title><author><name sortKey="Lungen, Eva M" sort="Lungen, Eva M" uniqKey="Lungen E" first="Eva M" last="Lüngen">Eva M. Lüngen</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Maier, Viktoria" sort="Maier, Viktoria" uniqKey="Maier V" first="Viktoria" last="Maier">Viktoria Maier</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Venhoff, Nils" sort="Venhoff, Nils" uniqKey="Venhoff N" first="Nils" last="Venhoff">Nils Venhoff</name><affiliation><nlm:affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Salzer, Ulrich" sort="Salzer, Ulrich" uniqKey="Salzer U" first="Ulrich" last="Salzer">Ulrich Salzer</name><affiliation><nlm:affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Dersch, Rick" sort="Dersch, Rick" uniqKey="Dersch R" first="Rick" last="Dersch">Rick Dersch</name><affiliation><nlm:affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Berger, Benjamin" sort="Berger, Benjamin" uniqKey="Berger B" first="Benjamin" last="Berger">Benjamin Berger</name><affiliation><nlm:affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Riering, Anne N" sort="Riering, Anne N" uniqKey="Riering A" first="Anne N" last="Riering">Anne N. Riering</name><affiliation><nlm:affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Nickel, Kathrin" sort="Nickel, Kathrin" uniqKey="Nickel K" first="Kathrin" last="Nickel">Kathrin Nickel</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Fiebich, Bernd L" sort="Fiebich, Bernd L" uniqKey="Fiebich B" first="Bernd L" last="Fiebich">Bernd L. Fiebich</name><affiliation><nlm:affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Su, Patrick" sort="Su, Patrick" uniqKey="Su P" first="Patrick" last="Sü">Patrick Sü</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Maier, Simon J" sort="Maier, Simon J" uniqKey="Maier S" first="Simon J" last="Maier">Simon J. Maier</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Egger, Karl" sort="Egger, Karl" uniqKey="Egger K" first="Karl" last="Egger">Karl Egger</name><affiliation><nlm:affiliation>Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Tebartz Van Elst, Ludger" sort="Tebartz Van Elst, Ludger" uniqKey="Tebartz Van Elst L" first="Ludger" last="Tebartz Van Elst">Ludger Tebartz Van Elst</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Endres, Dominique" sort="Endres, Dominique" uniqKey="Endres D" first="Dominique" last="Endres">Dominique Endres</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2019">2019</date><idno type="RBID">pubmed:31105597</idno><idno type="pmid">31105597</idno><idno type="doi">10.3389/fpsyt.2019.00226</idno><idno type="wicri:Area/PubMed/Corpus">000052</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000052</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Systemic Lupus Erythematosus With Isolated Psychiatric Symptoms and Antinuclear Antibody Detection in the Cerebrospinal Fluid.</title><author><name sortKey="Lungen, Eva M" sort="Lungen, Eva M" uniqKey="Lungen E" first="Eva M" last="Lüngen">Eva M. Lüngen</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Maier, Viktoria" sort="Maier, Viktoria" uniqKey="Maier V" first="Viktoria" last="Maier">Viktoria Maier</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Venhoff, Nils" sort="Venhoff, Nils" uniqKey="Venhoff N" first="Nils" last="Venhoff">Nils Venhoff</name><affiliation><nlm:affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Salzer, Ulrich" sort="Salzer, Ulrich" uniqKey="Salzer U" first="Ulrich" last="Salzer">Ulrich Salzer</name><affiliation><nlm:affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Dersch, Rick" sort="Dersch, Rick" uniqKey="Dersch R" first="Rick" last="Dersch">Rick Dersch</name><affiliation><nlm:affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Berger, Benjamin" sort="Berger, Benjamin" uniqKey="Berger B" first="Benjamin" last="Berger">Benjamin Berger</name><affiliation><nlm:affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Riering, Anne N" sort="Riering, Anne N" uniqKey="Riering A" first="Anne N" last="Riering">Anne N. Riering</name><affiliation><nlm:affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Nickel, Kathrin" sort="Nickel, Kathrin" uniqKey="Nickel K" first="Kathrin" last="Nickel">Kathrin Nickel</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Fiebich, Bernd L" sort="Fiebich, Bernd L" uniqKey="Fiebich B" first="Bernd L" last="Fiebich">Bernd L. Fiebich</name><affiliation><nlm:affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Su, Patrick" sort="Su, Patrick" uniqKey="Su P" first="Patrick" last="Sü">Patrick Sü</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Maier, Simon J" sort="Maier, Simon J" uniqKey="Maier S" first="Simon J" last="Maier">Simon J. Maier</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Egger, Karl" sort="Egger, Karl" uniqKey="Egger K" first="Karl" last="Egger">Karl Egger</name><affiliation><nlm:affiliation>Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Tebartz Van Elst, Ludger" sort="Tebartz Van Elst, Ludger" uniqKey="Tebartz Van Elst L" first="Ludger" last="Tebartz Van Elst">Ludger Tebartz Van Elst</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Endres, Dominique" sort="Endres, Dominique" uniqKey="Endres D" first="Dominique" last="Endres">Dominique Endres</name><affiliation><nlm:affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Frontiers in psychiatry</title><idno type="ISSN">1664-0640</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><b>Background:</b> Organic psychiatric disorders can be caused by immunological disorders, such as autoimmune encephalitis or systemic lupus erythematosus (SLE). SLE can affect most organs, as well as the central nervous system (CNS). In this paper, we describe a patient with an isolated psychiatric syndrome in the context of SLE and discuss the role of antibody detection in the cerebrospinal fluid (CSF). <b>Case presentation:</b> The 22-year-old German male high school graduate presented with obsessive-compulsive and schizophreniform symptoms. He first experienced obsessive-compulsive symptoms at the age of 14. At the age of 19, his obsessive thoughts, hallucinations, diffuse anxiety, depressed mood, severe dizziness, and suicidal ideation became severe and did not respond to neuroleptic or antidepressant treatment. Due to increased antinuclear antibodies (ANAs) with anti-nucleosome specificity in serum and CSF, complement activation, multiple bilateral white matter lesions, and inflammatory CSF alterations, we classified the complex syndrome as an isolated psychiatric variant of SLE. Immunosuppressive treatment with two times high-dose steroids, methotrexate, and hydroxychloroquine led to a slow but convincing improvement. <b>Conclusion:</b> Some patients with psychiatric syndromes and increased ANA titers may suffer from psychiatric variants of SLE, even if the American College of Rheumatology criteria for SLE are not met. Whether the psychiatric symptoms in our patient represent a prodromal stage with the later manifestation of full-blown SLE or a subtype of SLE with isolated CNS involvement remains unclear. Regardless, early diagnosis and initiation of immunosuppressive treatment are essential steps in preventing further disease progression and organ damage. Intrathecal ANAs with extractable nuclear antigen differentiation may be a more sensitive marker of CNS involvement compared with serum analyses alone.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">31105597</PMID><DateRevised><Year>2020</Year><Month>02</Month><Day>25</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Print">1664-0640</ISSN><JournalIssue CitedMedium="Print"><Volume>10</Volume><PubDate><Year>2019</Year></PubDate></JournalIssue><Title>Frontiers in psychiatry</Title><ISOAbbreviation>Front Psychiatry</ISOAbbreviation></Journal><ArticleTitle>Systemic Lupus Erythematosus With Isolated Psychiatric Symptoms and Antinuclear Antibody Detection in the Cerebrospinal Fluid.</ArticleTitle><Pagination><MedlinePgn>226</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3389/fpsyt.2019.00226</ELocationID><Abstract><AbstractText><b>Background:</b> Organic psychiatric disorders can be caused by immunological disorders, such as autoimmune encephalitis or systemic lupus erythematosus (SLE). SLE can affect most organs, as well as the central nervous system (CNS). In this paper, we describe a patient with an isolated psychiatric syndrome in the context of SLE and discuss the role of antibody detection in the cerebrospinal fluid (CSF). <b>Case presentation:</b> The 22-year-old German male high school graduate presented with obsessive-compulsive and schizophreniform symptoms. He first experienced obsessive-compulsive symptoms at the age of 14. At the age of 19, his obsessive thoughts, hallucinations, diffuse anxiety, depressed mood, severe dizziness, and suicidal ideation became severe and did not respond to neuroleptic or antidepressant treatment. Due to increased antinuclear antibodies (ANAs) with anti-nucleosome specificity in serum and CSF, complement activation, multiple bilateral white matter lesions, and inflammatory CSF alterations, we classified the complex syndrome as an isolated psychiatric variant of SLE. Immunosuppressive treatment with two times high-dose steroids, methotrexate, and hydroxychloroquine led to a slow but convincing improvement. <b>Conclusion:</b> Some patients with psychiatric syndromes and increased ANA titers may suffer from psychiatric variants of SLE, even if the American College of Rheumatology criteria for SLE are not met. Whether the psychiatric symptoms in our patient represent a prodromal stage with the later manifestation of full-blown SLE or a subtype of SLE with isolated CNS involvement remains unclear. Regardless, early diagnosis and initiation of immunosuppressive treatment are essential steps in preventing further disease progression and organ damage. Intrathecal ANAs with extractable nuclear antigen differentiation may be a more sensitive marker of CNS involvement compared with serum analyses alone.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lüngen</LastName><ForeName>Eva M</ForeName><Initials>EM</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maier</LastName><ForeName>Viktoria</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Venhoff</LastName><ForeName>Nils</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Salzer</LastName><ForeName>Ulrich</ForeName><Initials>U</Initials><AffiliationInfo><Affiliation>Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dersch</LastName><ForeName>Rick</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Berger</LastName><ForeName>Benjamin</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Riering</LastName><ForeName>Anne N</ForeName><Initials>AN</Initials><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nickel</LastName><ForeName>Kathrin</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fiebich</LastName><ForeName>Bernd L</ForeName><Initials>BL</Initials><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Süß</LastName><ForeName>Patrick</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maier</LastName><ForeName>Simon J</ForeName><Initials>SJ</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Egger</LastName><ForeName>Karl</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tebartz van Elst</LastName><ForeName>Ludger</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Endres</LastName><ForeName>Dominique</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>04</Month><Day>25</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Front Psychiatry</MedlineTA><NlmUniqueID>101545006</NlmUniqueID><ISSNLinking>1664-0640</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">neuropsychiatric systemic lupus erythematosus</Keyword><Keyword MajorTopicYN="N">obsessive-compulsive disorder (OCD)</Keyword><Keyword MajorTopicYN="N">psychosis</Keyword><Keyword MajorTopicYN="N">schizophrenia</Keyword><Keyword MajorTopicYN="N">systemic lupus erythematosus</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>01</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>03</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>5</Month><Day>21</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>5</Month><Day>21</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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