We describe a 15-year-old African American female with a family history positive for Bipolar I disorder and schizophrenia who presented with symptoms consistent with an affective disorder. The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic workup, which revealed cerebral vasculitis. Neuropsychiatric lupus (NPSLE) was diagnosed and, following treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy.

Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in 80-91% of adults and up to 95% of pediatric patients with SLE. In the case we described, diagnosis was hindered by the patient's presentation of what appeared to be isolated psychiatric symptoms and her strong family history of psychiatric disease. Thus, given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent may indeed be the initial manifestations of SLE.