This is a nicely written case report. I would like to congratulate the authors. There's one point I would like to express. This report interests mostly neurologists but all neurologists may not know the full diagnostic criteria of SLE. I believe that adding the daignostic criteria will raise the value of the paper.

Best regards,

Özgür Bilgin Topçuoğlu, MD

I have treated neuro-lupus patients for about five years in different institutions.

  It has been an interesting case report of a young patient presenting with an atypical clinical picture resembling meningoencephalitis and finally being diagnosed as SLE. Although it is not a new and original contribution, this report indicates once more the importance of systemic investigations when evaluating patients with acute focal neurological deficits. I have only a few suggestions about some of the statements.

  In the fourth paragraph beginning with “In view of her neurological status and evidence of active SLE, she was diagnosed as having definite SLE…”, it would be better not to mention about fever and lymphadenopathy, as they are not included in the ACR criteria. The patient can already be diagnosed as SLE by photosensitivity, malar rash, renal dysfunction, hematological disorder (thrombocytopenia, neutropenia, lymphopenia) and neurological disorder.

  “MR images compatible with vasculitis” could be replaced with “suggestive of vasculitis”. Because as we know true CNS vasculitis is rarely seen in SLE and it would be inappropriate to use a definitive statement such as “compatible with” without biopsy,etc just depending on MRI images. Nevertheless, there are many mechanisms of NPSLE other than vasculitis, such as vasculopathy, thromboemboli, etc, as the authors emphasized in the discussion section.

  I think the quality of the diction is satisfactory, except the last sentence of the conclusion section. It has been a complicated long sentence with some grammatical errors (found vs was found). Overall the manuscript is gripping with appropriate length and structure.

We are frequently consulted about neurological symptoms of lupus patients by our Rheumatology Clinic. Although I do not have exclusive experience on patients with NPSLE, I have been investigating patients with another connective tissue disease, Neurobehcet Syndrome with my colleagues and have been following some patients with differential diagnosis of SLE.

This case report is informative

Yes, we follow SLE patients with CNS involvement in our clinic.