Dystonic tremor in Systemic Lupus Erythematous and Antiphospholipid syndrome

Introduction
In Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome, dystonia and
dystonic tremor are infrequently reported but can stem from diverse neurological complications. We
describe a case of a 65-year-old retired chemistry teacher with a decade-long history of lupus and
hematological manifestations, who reported a progressively worsening tremor following an SLE
exacerbation.
Methods
Extensive laboratory testing, neurological follow up, neuroimaging and EMG.
Results
: Laboratory tests indicated abnormalities in hematological and biochemical parameters, and
autoimmune markers such as positive antinuclear antibodies (ANA) and anti double-stranded DNA (anti
dsDNA). Neurological examination revealed exssesive finger flexion, predominantly on the left hand, left
forearm pronation, bilateral tremors, predominantly left-sided, along with hyporeflexia.
Neuroimaging showed widespread cortical atrophy, ventricular enlargement, vasculopathic changes in
the basal ganglia, and encephalopathic alterations. EMG showed co-contracting electromyographic bursts
in the left forearm.
Conclusion
n SLE, various movement disorders, including tremors and dystonic tremors have been
described. Antiphospholipid syndrome (APS), often associated with SLE, may contribute to neurologic
manifestations through immune-mediated mechanisms leading to thrombosis.
The complex multisystem nature of SLE and the overlapping features with APS present challenges in
understanding their distinct or interconnected pathophysiology. Treatment options for movement
disorders in the context of APS and SLE include immunotherapy, anticoagulation, antiplatelet agents, and
symptomatic management based on the specific type of movement disorder. This case highlights the need
for a comprehensive approach in addressing neurological manifestations in the context of autoimmune
disorders.