Description A 32-year old Indonesian female patient of lower socioeconomic status with an urban background was admitted to our hospital with seizures three hours before hospital admission. She was just diagnosed with SLE three months ago after having recurrent seizures days prior to diagnosis, and at the time of our hospital admission she was under 48 mg/day of methylprednisolone (tablet) in divided doses. At the time of SLE diagnosis, she was brought by her family to our satellite hospital with seizures as a chief complaint, and the in-charge doctor recognized discoid rash on her face. At that time, the patient was unconscious, but her family told the doctor that she had reddish rash on her face for many years before, and also had occasional arthralgia on her hands, both considered not a big problem by the patient and her family. At the time of admission to our hospital, the patient was conscious but had slurred speech and occasional anger outbursts. Physical examination showed non-scarring alopecia, and decreased muscle strength and hypotonia in all four extremities. The patient also complained of having an increased sense of pain in the whole body, especially in the cervical region and trunks. The laboratory examination showed elevated levels of anti-dsDNA, C-reactive protein, and lactate dehydrogenase, and low levels of complement components 3 and 4. MRI showed multiple small hyperintense lesions in bilateral white matter frontal lobes. Following the exclusion of other possible diseases, neuropsychiatric lupus was diagnosed.

Conclusions This case showed a common condition of delay in autoimmune diagnosis in Indonesia, even in urban areas, which is not surprising to happen in rural areas. Therefore, community education is needed so that more people are aware of autoimmune diseases’ signs and symptoms.