Objective: The aim is to report a case of a 4 yearlong postpartum autoimmune chorea secondary to incomplete SLE/APS.

Background: Chorea is a movement disorder characterized by brief and abrupt involuntary movements. Autoimmune diseases can develop during pregnancy and especially after delivery such as Systemic Lupus Erythematous (SLE) and Anti-phospholipid Syndrome (APS). SLE is a known etiology of autoimmune chorea. A certain number of patients do not fulfill all the SLE/APS diagnostic criteria, these have been referred as incomplete SLE/APS chorea in the literature. It is in this group that SLE chorea usually appears early in the disease. Therefore, recognizing it among the criteria could be an opportunity to anticipate SLE diagnosis.

Method: A 35-year-old Hispanic female who denied previous history of COVID-19, presented with a past medical history of 4 years of forgetfulness, auditory hallucinations, and dysarthria. She also complained of facial tics, bradypsychia, dizziness, lack of coordination, dysphagia, and involuntary movements in hands, torso, and abdomen with sudden onset at the third month after delivery.  
Physical examination showed mild memory impairment, hypomimia, anxiety, left deviated uvula, with dystussia, abdominal fasciculation, hyperekplexia, bilateral Hoffman, left Marinescu and writer hand dystonia. As well as Romberg’s were found. Choreiform movements were focused on the left upper limb, abdomen and legs, and internal tibial and femoral rotation. Bloodwork showed ANA 1/80, hypocortisolism, indeterminate anti-GAD, and LP was normal expect for elevated IgG index.  
MRI showed bilateral frontal medial cortical hyperintensity, compromised caudates, mild ventriculomegaly with hypertrophic pachymeningitis. Spectroscopy with decreased NAA, choline and creatine and increased lactate.

Results: The patient had almost complete resolution of symptoms after immunosuppressive treatment with IV methylprednisolone, steroids and azathioprine. Patient also received levodopa, clonazepam, baclofen, valproic acid and memantine, with improvement of symptoms.

Conclusion: Postpartum stage may induce an exacerbation of autoimmune disease such as SLE. Neuropsychiatric SLE/APS manifestations include Autoimmune chorea and should be considered as an early in the diagnosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/4-yearlong-post-partum-autoimmune-chorea-as-initial-presentation-of-incomplete-sle-aps/