{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:09:37Z","timestamp":1780664977608,"version":"3.54.1"},"reference-count":34,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,3]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Paediatric-onset systemic lupus erythematosus (SLE) is a rare but clinically significant condition, often presenting with central nervous system (CNS) involvement. The most common CNS manifestations include headaches, seizures and psychosis. We present two cases of neuropsychiatric SLE with unusual clinical and imaging features.<\/jats:p>\n                  <jats:p>The first case involves an adolescent girl who presented with unilateral vision loss and elevated intracranial pressure. MRI revealed large well-defined ring-enhancing lesions in the bilateral subcortical white matter. She underwent extensive evaluation for infectious, autoimmune and demyelinating causes.<\/jats:p>\n                  <jats:p>The second case concerns another adolescent girl who presented with bilateral vision loss, with MRI showing small ring-enhancing lesions in the brain. Both patients had initially been treated for CNS tuberculosis with anti-tuberculous therapy before being referred to our hospital.<\/jats:p>\n                  <jats:p>In both cases, the diagnosis of SLE was confirmed by elevated anti-double-stranded DNA antibody levels. Both patients responded favourably to immunotherapy. These cases add to the existing literature by describing unique manifestations of neuropsychiatric SLE in children and emphasising the importance of early diagnosis and timely intervention to improve outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-270349","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T12:25:25Z","timestamp":1780662325000},"page":"e270349","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ring-enhancing demyelinating lesions in the brain and optic neuritis: atypical presentation of paediatric neuropsychiatric SLE"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7655-6222","authenticated-orcid":false,"given":"Mohammad","family":"Raza","sequence":"first","affiliation":[{"name":"Pediatrics, The Aga Khan University Hospital Main Campus Karachi, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5092-6168","authenticated-orcid":false,"given":"Hamna","family":"Jaskani","sequence":"additional","affiliation":[{"name":"Medical College, The Aga Khan University Hospital Main Campus Karachi, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4839-6943","authenticated-orcid":false,"given":"Maham","family":"Jaskani","sequence":"additional","affiliation":[{"name":"Department of Biological and Biomedical Sciences, The Aga Khan University Hospital Main Campus Karachi, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026060505250893000_19.6.e270349.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23204"},{"key":"2026060505250893000_19.6.e270349.2","first-page":"1542","article-title":"Differences in 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