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Invasive candida infection as the cause of seizure in a patient with systemic lupus erythematosus: a report of unusual case

  • Mirza Suryo Adi ,
  • Awalia Awalia ,


Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a complication of SLE involving the nervous and psychiatric systems with clinical manifestations including seizures, strokes, myelopathy, neuritis, meningitis, and psychosis. Seizures in NPSLE might be caused by intracranial infection, with bacteria as the most common pathogens. This study reported a rare case of seizure in a SLE patient due to invasive Candida infection.

Case Presentation: A 26-year-old female presented in the emergency department of Dr. Soetomo Hospital Surabaya, Indonesia with seizure, which she has experienced in the last 2 days prior to hospital admission. She experienced a convulsion that lasted 5-10 minutes followed by loss of consciousness. The patient also complained of severe headaches two days before hospital admission. She was diagnosed with SLE in November 2022 and was currently taking methylprednisolone. Physical examination showed Glasgow Coma Scale (GCS) of E3V4M5, fever, dyspnea, and rough rhonchi on the right lung. Chest X-ray indicated pneumonia, while brain computed tomography (CT) suggested subacute to chronic thromboembolism. The patient was diagnosed with NPSLE due to intracranial infection, and hospital-acquired pneumonia (HAP), and was given Levofloxacin. On the 3rd day, a reddish lesion with central healing was found on the cheeks, and the patient had dyspnea, suggesting fungi infection. Methylprednisolone was stopped while fluconazole and urine cultures were initiated. Urine culture suggested Fluconazole-sensitive Candida and consultation with a dermato-venerologist confirmed Candida, thus, Fluconazole was continued along with dexamethasone, and Levofloxacin. The patient showed clinical improvement and was discharged after 12 days.

Conclusion: Seizure is one of the most common manifestations of NPSLE, due to intracranial infection. Although rare, we cannot rule out the possibility of fungal infection in NPSLE patients with intracranial infection. Early diagnosis and prompt treatment are critical for better prognosis, as shown in this patient.


  1. Sutanto H, Yuliasih Y. Disentangling the Pathogenesis of Systemic Lupus Erythematosus: Close Ties between Immunological, Genetic and Environmental Factors. Medicina (Kaunas). 2023;59(6):1033. Available from:
  2. Barber MRW, Drenkard C, Falasinnu T, Hoi A, Mak A, Kow NY, et al. Global epidemiology of systemic lupus erythematosus. Nat Rev Rheumatol. 2021/08/03. 2021;17(9):515–32. Available from:
  3. Vaillant AAJ, Goyal A, Varacallo M. Systemic Lupus Erythematosus. August 4, 2023 2023. (accessed 20 December 2023).
  4. Sarwar S, Mohamed AS, Rogers S, Sarmast ST, Kataria S, Mohamed KH, et al. Neuropsychiatric Systemic Lupus Erythematosus: A 2021 Update on Diagnosis, Management, and Current Challenges. Cureus. 2021;13(9):e17969–e17969. Available from:
  5. Sompa AW, Harun H, Mimika RA, Bahtiar RR. Neurological manifestations of COVID-19 in Indonesia: Assessment of the role of sex and age. Narra J. 2023;3(3):e277. Available from:
  6. Rodriguez-Hernandez A, Ortiz-Orendain J, Alvarez-Palazuelos LE, Gonzalez-Lopez L, Gamez-Nava JI, Zavala-Cerna MG. Seizures in systemic lupus erythematosus: A scoping review. Seizure. 2021;86:161–7. Available from:
  7. Rana NRE, Awaliah A, Hernaningsih Y, Hidayati HB. Neuropsychiatric manifestations in systemic lupus erythematosus at Dr. Soetomo Surabaya. Maj Kedokt Neurosains Perhimpun Dr Spes Saraf Indones. 2020;36(4). Available from:
  8. Trilistyoati D, Agustina B, Awalia A. CLINICAL Profile And Incidence Of Infection In Systemic Lupus Erythematosus Patients At Medical Inpatient Installation, Department Of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia In 2016. Maj Biomorfologi. 2021;31(2):49. Available from:
  9. Fitriah M, Rahmawati LD, Wulanda IA, Susianti H, Tambunan BA. The Discrepancy of ANA and Compartment Bead Patterns Suggestive of a Neuropsychiatry Systemic Lupus Erythematosus (NPSLE). Case Rep Psychiatry. 2023;2023:5260208. Available from:
  10. Ghafirah B, Yuliasih Y, Moediarso B. Mortality Incidence Of Systemic Lupus Erythematosus In Dr. Soetomo General Hospital Surabaya. Curr Intern Med Res Pract Surabaya J. 2022;3(2):43–6. Available from:
  11. Damara I, Winston K, Maulida F, Ariane A. Factors Associated With Candidiasis in Systemic Lupus Erythematosus Patients in Cipto Mangunkusumo National General Hospital: A Single-Center Case-Control Study. Cureus. 2022;14(7):e27107–e27107. Available from:
  12. Su C-F, Lai C-C, Li T-H, Chang Y-F, Lin Y-T, Chen W-S, et al. Epidemiology and risk of invasive fungal infections in systemic lupus erythematosus: a nationwide population-based cohort study. Ther Adv Musculoskelet Dis. 2021;13:1759720X211058502-1759720X211058502. Available from:
  13. Iftikhar PM, Munawar M, Hasan CA, FaisalUddin M, Cohen A. A Challenging Diagnosis of Systemic Lupus Erythematosus with Status Epilepticus. Cureus. 2019;11(5):e4783–e4783. Available from:
  14. Fane M, Sodqi M, S J, Marih L, Chakib A, Km EL. Invasive Fungal Infection as the Initial Presentation of Systemic Lupus Erythematosus. J Antimicrob Agents. 2017;03(03). Available from:
  15. Meena DS, Kumar D. Candida Pneumonia: An Innocent Bystander or a Silent Killer? Med Princ Pract. 2021/10/12. 2022;31(1):98–102. Available from:
  16. Barantsevich N, Barantsevich E. Diagnosis and Treatment of Invasive Candidiasis. Antibiot (Basel, Switzerland). 2022;11(6):718. Available from:
  17. Dias V. Candida species in the urinary tract: is it a fungal infection or not? Future Microbiol. 2020;15(2):81–3. Available from:
  18. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2015/12/16. 2016;62(4):e1–50. Available from:

How to Cite

Adi, M. S., & Awalia, A. . (2024). Invasive candida infection as the cause of seizure in a patient with systemic lupus erythematosus: a report of unusual case. Bali Medical Journal, 13(1), 835–839.




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