Associations of cognitive function with recent and cumulative per- and polyfluoroalkyl substances exposure in firefighters.

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder characterised by the production of autoantibodies and immune-mediated tissue damage. Neuropsychiatric involvement occurs in approximately 30-40% of patients and encompasses a wide spectrum of neurological and psychiatric manifestations collectively termed neuropsychiatric systemic lupus erythematosus (NPSLE) []. Given the multifaceted symptoms, the unpredictability of onset of presentation relative to the SLE disease course, and the gaps in the understanding of its pathogenesis, NPSLE can be quite challenging to diagnose.  The American College of Rheumatology recognises 19 different neuropsychiatric syndromes associated with SLE []. The pathogenesis is multifactorial and may involve inflammatory mechanisms, autoantibody-mediated neuronal injury, microvascular thrombosis, or cytokine-driven neurotoxicity []. Among these manifestations, basal ganglia involvement and catatonia are rare but increasingly recognised. As highlighted in this report, there are a handful of case reports that have described evidence of striatal involvement in NPSLE, but more epidemiological studies are needed to truly quantify its rarity. Catatonia is a complex neuropsychiatric syndrome of both hypo- and hyperkinetic movement and behavioural abnormalities, often associated with many psychiatric and organic brain conditions. Psychomotor signs range from stupor to agitation and include pathognomonic features such as verbigeration and waxy flexibility. Severe and complicated cases often result in autonomic instability (malignant catatonia), which can be fatal if unrecognised and untreated [].