# Acute Encephalopathy Workup for a Patient With a History of Lupus Cerebritis and Unremarkable Inflammatory Markers: A Case Report

## TL;DR

This case report describes a lupus patient with acute encephalopathy and highlights the diagnostic challenges and treatment approach for lupus cerebritis.

## Contribution

The report emphasizes the potential for empiric steroid treatment in lupus patients with acute encephalopathy and inconclusive tests.

## Key findings

- A 65-year-old lupus patient presented with acute encephalopathy and was treated with high-dose steroids.
- Symptoms resolved following treatment despite unremarkable inflammatory markers and inconclusive diagnostics.
- The case suggests empiric steroid treatment may be considered in similar lupus cerebritis scenarios.

## Abstract

Lupus is a relatively rare disease; however, many of the patients diagnosed with lupus experience an acute confusional state. Despite the prevalence, lupus cerebritis remains a diagnosis of exclusion due to the number of differential diagnoses of the cause of acute confusional state and unreliable clinical markers. This case report highlights the significant duration it takes to work up a broad differential before initiating treatment for lupus. Our case involves a 65-year-old woman with a documented history of lupus, who presented with acute encephalopathy. Following the comprehensive diagnostic investigation, the patient was treated with high-dose steroids that resolved the patient’s symptoms. This report considers the option of empiric steroid treatment in the setting of acute encephalopathy in individuals with a history of lupus cerebritis with inconclusive test results.