Case presentation: A 22-year-old Hispanic male with history of SLE, presented to our hospital with four weeks history of progressive worsening upper and lower extremities weakness and feet paresthesia. He was initially admitted to another hospital where MRI lumbar spine was suggestive of lumbar spinal roots enhancement, and CSF analysis showed elevated CSF protein with normal white cell count consistent with albuminocytologic dissociation.  He was treated with 2 gr/kg Intravenous immunoglobulin (IVIG) over 5 days with diagnosis of AIDP and was discharged. One day after discharge, he presented to our hospital due to worsening weakness. On our neuroexamination, he had symmetric proximal and distal muscle weakness on upper and lower extremities with decreased deep tendon reflexes. Electrodiagnostic study was suggestive of AIPD. CSF studies again was consistent with albuminocytologic dissociation. Brain MRI showed diffuse T2 hyperintensity in the pons, as well as mild patchy periventricular and right corona radiata and centrum semiovale T2 hyperintensities suggestive of central demyelination process.  Considering history of SLE that was established a year ago and current AIPD nonresponding to IVIG treatment, and recent brain MRI changes, we started treatment with pulse steroid followed by Cyclophosphamide with diagnosis of central and peripheral demyelination due to underlying SLE. His symptoms significantly improved after treatment.

Peripheral demyelinating syndrome including AIDP as well as central demyelinating syndromes are rare presentations in SLE. To the best of our knowledge, there has not been any report of simultaneous presentation of central and peripheral demyelination in a patient with SLE.