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首页> 外文期刊>Frontiers in Psychiatry >Schizophrenia or Atypical Lupus Erythematosus with Predominant Psychiatric Manifestations over 25?Years: Case Analysis and Review
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Schizophrenia or Atypical Lupus Erythematosus with Predominant Psychiatric Manifestations over 25?Years: Case Analysis and Review

机译：25岁以上精神分裂症或非典型性红斑狼疮伴主要精神病表现：病例分析与回顾

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We observed a case over 25?years of relapsing–remitting schizophrenic spectrum disorder, varying regarding the main symptomatology between more depressive or more schizoaffective or rather typical schizophrenic syndrome. Diseased phases were repeatedly accompanied by minor skin lesions, which were initially classified as mixed tissue disorder. Psychotic phases were waxing–waning over years. During one later relapse, skin involvement was severe, classified to likely represent an allergic reaction to psychopharmaca; this generalized exanthema remitted rapidly with cortisone treatment and azathioprine. Under continued azathioprine and low dose neuroleptics, the patient remitted completely, appearing psychiatrically healthy for 16?years. When azathioprine was set off due to pregnancy, an extraordinary severe relapse of schizophrenia like psychosis accompanied by most severe skin lesions developed within a few weeks, then requiring 2?years of psychiatric inpatient treatment. Finally, a diagnosis of systemic lupus erythematodes plus neuropsychiatric lupus was made. A single CSF sample in 2013 showed suspicious biomarkers, matching with CSF cytokine profiling in schizophrenic and affective spectrum disorder patients and indicated mild neuroinflammation. Complex immune suppressive treatment was reinitiated short after relapse, but was only partially successful. However, surprisingly the psychosis and skin lesions remitted (in parallel) when belimumab was given (add-on). The very details of this complicated, long-term disease course are discussed also with regard to general ideas, in particular with respect to the question if this case of seemingly comorbid schizophrenia with minor autoimmunity signs represented a case of one emerging autoimmune disorder with variant manifestations systemically and within the CNS, though atypically with predominant appearance as a schizophrenia spectrum disorder.
机译：我们观察到超过25年的复发-缓解型精神分裂症谱系障碍病例，其主要症状在抑郁症或更趋于分裂性或典型精神分裂症综合征之间有所不同。患病阶段反复伴有轻微的皮肤损伤，最初被分类为混合组织疾病。多年来，精神病阶段逐渐减少。在随后的一次复发中，皮肤受累很严重，被分类为可能代表对精神药物的过敏反应。可的松治疗和硫唑嘌呤可迅速缓解这种全身性皮疹。在持续的硫唑嘌呤和低剂量的抗精神病药治疗下，患者完全缓解，精神健康良好，持续了16年。当硫唑嘌呤由于怀孕而引燃时，精神分裂症如精神病的异常严重复发，伴随着最严重的皮肤损害，在几周内就出现了，因此需要住院2年的精神病治疗。最后，对系统性红斑狼疮加神经精神性狼疮进行了诊断。 2013年，单个CSF样本显示出可疑的生物标志物，与精神分裂症和情感谱系障碍患者的CSF细胞因子谱相符，并显示轻度神经炎症。复发后不久重新开始进行复杂的免疫抑制治疗，但仅部分成功。然而，令人惊讶的是，当给予贝利木单抗（附加）时，精神病和皮肤病变得以缓解（并行）。还讨论了这种复杂的，长期的疾病过程的非常详细的一般概念，尤其是关于以下问题：这种看似合并的精神分裂症伴有较小的自身免疫性症状，是否代表一种正在出现的变异性表现的自身免疫性疾病？尽管非典型地以精神分裂症谱系障碍为主，但在全身和中枢神经系统内。

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