Acute stroke as the initial manifestation of neuropsychiatric lupus erythematosus and anti-phospholipid syndrome in a child patient.

Introduction and importance: Neurologic disorders are among the most significant clinical symptoms of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), primarily affecting the central nervous system. Both SLE and APS increase the risk of cerebrovascular events, and stroke is one of the most serious and late consequences that often occur years after diagnosis. Stroke as an initial symptom is uncommon in its early stages and frequently misinterpreted as ischemic cerebrovascular illness, posing diagnostic challenges. Case report: A 15-year-old female patient presented to the emergency department with a history of right-sided body weakness, mouth deviation, and dysarthria. A brain MRI revealed a complete occlusion of the left MCA with multiple acute left periventricular ischemia. She was referred for urgent brain catheterization, where complete recanalization of the MCA was performed. Extensive investigations were performed, including serological laboratory studies, which led to a subsequent diagnosis of SLE and APS. Clinical discussion: Ischemic stroke is a serious and late consequence of SLE and APS that often occurs years after diagnosis. Ischemic stroke as an initial symptom is uncommon in its early stages and frequently misinterpreted. Conclusion: This case exemplifies a sudden and possibly fatal presentation of SLE and APS in pediatric patients, emphasizing the need of early recognition and tailored treatment in influencing the disease's progression and outcomes.