Hospital Medicine, University of Kentucky, Lexington, Kentucky, USA
Hospital Medicine, University of Kentucky, Lexington, Kentucky, USA.
BMJ Case Rep. 2024 Jan 30;17(1):e257086. doi: 10.1136/bcr-2023-257086.
Chorea can be an initial manifestation of systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS). It has been mostly described in younger female adults in association with other manifestations of SLE. When chorea appears as an initial and only manifestation in SLE/APS patients, the establishment of the correct diagnosis is difficult, and it may be initially attributed to a more common aetiology. Here we report an elderly man who presented with a new onset of right-sided chorea without other clinical manifestations of SLE/APS. He started on steroids a year later, however, there was no improvement. His chorea was symptomatically managed along with aspirin, and hydroxychloroquine as he refused to be on additional immunosuppression. Anticoagulation was relatively contraindicated, and also not favoured by this patient; therefore, aspirin was initiated. Even in elderly patients, once the common etiologies of chorea have been worked up, we suggest doing a rheumatological evaluation. Early diagnosis and prompt treatment can prevent persistent neurological abnormality.
舞蹈症可为系统性红斑狼疮（SLE）或抗磷脂综合征（APS）的首发表现。它主要发生于年轻成年女性，常与 SLE 的其他表现相关。当舞蹈症作为 SLE/APS 患者的首发和唯一表现时，正确诊断较困难，可能最初归因于更常见的病因。我们在此报告一位老年男性，其新发右侧舞蹈症，无 SLE/APS 的其他临床表现。1 年后他开始应用类固醇，但无改善。由于他拒绝接受额外免疫抑制治疗，故仅给予对症治疗（包括阿司匹林和羟氯喹）。尽管抗凝治疗相对禁忌，但也不被该患者所接受；因此，仅开始使用阿司匹林。即便在老年患者中，一旦舞蹈症的常见病因得到明确，我们建议进行风湿科评估。早期诊断和及时治疗可预防持续性神经功能异常。
