Aseptic Lymphocytic Meningitis Revealing Very Late-Onset Lupus in Man

Salem Bouomrani^1,2*, Mouna Dey³, Nesrine Rgaïeg^1,2, Houda Ghorbel⁴ & Mayada Ben Hamad^1,2

¹Department of Internal Medicine, Military Hospital of Gabes, Gabes 6000, Tunisia
²Sfax Faculty of Medicine, University of Sfax, Sfax 3029, Tunisia
³Department of Nephrology, Gabes Regional Hospital, Gabes 6000, Tunisia
⁴Department of Infectious Diseases, Gabes Regional Hospital, Gabes 6000, Tunisia

Dr. Salem Bouomrani, Department of Internal Medicine, Military Hospital of Gabes, Gabes 6000, Tunisia.

Keywords: Lupus; Late-Onset; Aseptic Meningitis; Neurolupus; Elderly

Abstract

Introduction
Systemic lupus erythematosus (SLE) is an autoimmune disease that classically affects young women. The onset of the disease after the age of 65 (a very late- onset lupus) remains exceptional and unusual. We are reporting an original observation of aseptic lymphocytic meningitis inaugurating a very late-onset lupus in a man.
Case Report
A 73-year-old man, with no pathological medical history, was hospitalized in the department of infectious diseases for aseptic lymphocytic meningitis occurring after a simple flu syndrome. Initial explorations were negative and he was treated as herpetic meningoencephalitis. After four months, he presented edema of lower limbs with 24h proteinuria at 2g, aseptic leukocyturia at 30,000/ml and hematuria at 1,000/ml. Subsequent investigations supported the diagnosis of SLE with extra membranous lupus nephritis and central meningeal and parenchymal neurolupus.
The patient was treated with three boli of methylprednisolone followed by prednisone and hydroxychloroquine with a favourable evolution: negativation of proteinuria, normalization of lumbar puncture, leukocyte count, and urinary sediment at one month of treatment.

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