Objective:

To describe a rare presentation and MRI findings of pediatric neuropsychiatric systemic lupus erythematosus (NP-SLE).

Approach:

• Design: Peer-reviewed case report.
• Patient: A 13-year-old with newly diagnosed systemic lupus erythematosus developed acute cerebellar dysfunction, impaired consciousness, and nonconvulsive status epilepticus.
• Imaging: Advanced MRI showed cerebellar cortical diffusion restriction and bilateral thalamic signal abnormalities consistent with vasogenic edema, without vascular occlusion.

Key Findings:

• The patient had simultaneous acute cerebellar and bilateral thalamic involvement.
• The report describes these findings as expanding the recognized imaging spectrum of pediatric NP-SLE.
• Treatment included high-dose corticosteroids, antiseizure therapy, plasmapheresis, cyclophosphamide, and rituximab, followed by rehabilitation and maintenance therapy.
• The patient experienced gradual neurologic recovery.

Interpretation:

The authors emphasize distinguishing inflammatory NP-SLE from mimics such as posterior reversible encephalopathy syndrome, infection, and ischemia because management and prognosis differ.

Limitations:

• This is a single-patient case report and does not establish how frequently these imaging findings occur.

Sources:

• Anderson J, et al. Concurrent Thalamic and Cerebellar Involvement in Pediatric Neuropsychiatric Lupus: Expanding the Radiologic Spectrum. Lupus. 2026. PubMed ID 41674410.