Cranial Diabetes Insipidus in Neuropsychiatric Systemic Lupus Erythematosus, a Rare but Treatable Association: A Case Report

  • Alvin Oliver Payus Senior Lecturer in Internal Medicine, Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah
  • Malehah Mohd Noh Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
  • Constance Liew Sat Lin Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
  • Justin Leow Wen Hsiang General Medicine Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia
  • Ani Darwina Abdul Halim Radiology Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia

Abstract

Systemic lupus erythematosus has been rarely reported to be associated with cranial diabetes insipidus. It is a condition clinically manifest as severe polyuria and reactive polydipsia that may lead to electrolyte imbalance or acute kidney injury as a result of arginine vasopressin insufficiency. Here, we report a patient with systemic lupus erythematosus and lupus nephritis previously under control with medication presented with neuropsychiatric symptoms which responded to pulsed methylprednisolone, developed severe polyuria, polydipsia and hypernatremia which persisted after pulsed therapy. Serum and urine osmolarity were suggestive of diabetes insipidus and the polyuria resolved dramatically after trial of oral desmopressin which in keeping with the diagnosis of central cause. The objective of this case report is to share the uncommon occurrence of diabetes insipidus in neuropsychiatric systemic lupus erythematosus.

Author Biographies

Alvin Oliver Payus, Senior Lecturer in Internal Medicine, Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah
Senior Lecturer in Internal Medicine, Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah
Malehah Mohd Noh, Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
Senior Lecturer in Internal Medicine, Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah
Constance Liew Sat Lin, Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia
Senior Lecturer in Internal Medicine, Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah
Justin Leow Wen Hsiang, General Medicine Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia
Senior Medical Officer, General Medicine Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia
Ani Darwina Abdul Halim, Radiology Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia
Radiologist, Radiology Department, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200 Kota Kinabalu, Sabah, Malaysia

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Published
2020-03-10