Susac-syndrome is a rare autoimmune disease that manifests with mood alterations in up to 15% of cases and is usually treated with corticosteroids. We present the case of a 41-year-old woman with a first manic episode and history of Susac-syndrome, secondary Cushing's syndrome after receiving high doses of corticosteroids and a previous depressive episode. Differentiating between primary and secondary mania is difficult, as people with bipolar disorder are prone to multiple psychiatric and nonpsychiatric comorbidities, in this case, the differential diagnosis included secondary mania, corticoid-induced manic episode and primary bipolar disorder. Upon admission, corticosteroid treatment was suspended, and the patient was started on lithium and risperidone. Secondary causes of mania were discarded and, assessing temporal and dosage criteria, it was deemed unlikely that the present episode was corticosteroid-induced. One-year outpatient follow-up pointed towards a primary bipolar type I disorder, as a separate entity from her Susac-syndrome. Corticosteroid use or abrupt withdrawal pose an underestimated risk of inducing depressive or manic symptoms, which may unmask affective disorders in susceptible individuals. Many medical conditions share CNS involvement and/or high-dose/prolonged corticosteroid treatment. In such cases, psychiatric manifestations such as mania or depression should be regarded as secondary and studied to determine the existence of medical complications before considering primary psychiatric conditions.

中文翻译：

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双相情感障碍和 Susac 综合征：病例报告。

Susac 综合征是一种罕见的自身免疫性疾病，多达 15% 的病例表现为情绪改变，通常用皮质类固醇治疗。我们介绍了一名 41 岁女性的病例，她在接受高剂量皮质类固醇和先前的抑郁发作后首次出现躁狂发作和 Susac 综合征、继发性库欣综合征。区分原发性和继发性躁狂是困难的，因为双相障碍患者容易出现多种精神和非精神共病，在这种情况下，鉴别诊断包括继发性躁狂、皮质激素诱发的躁狂发作和原发性双相障碍。入院后暂停皮质类固醇治疗，患者开始服用锂盐和利培酮。排除了躁狂的次要原因，并评估了时间和剂量标准，目前的发作被认为不太可能是皮质类固醇诱发的。一年的门诊随访表明原发性双相 I 型障碍是独立于她的 Susac 综合征的个体。皮质类固醇的使用或突然停药会导致被低估的诱发抑郁或躁狂症状的风险，这可能会暴露易感个体的情感障碍。许多医疗条件共享中枢神经系统受累和/或高剂量/长期皮质类固醇治疗。在这种情况下，躁狂或抑郁等精神症状应被视为继发性，并在考虑原发性精神疾病之前进行研究以确定是否存在医学并发症。作为一个独立于她的 Susac 综合征的实体。皮质类固醇的使用或突然停药会导致被低估的诱发抑郁或躁狂症状的风险，这可能会暴露易感个体的情感障碍。许多医疗条件共享中枢神经系统受累和/或高剂量/长期皮质类固醇治疗。在这种情况下，躁狂或抑郁等精神症状应被视为继发性，并在考虑原发性精神疾病之前进行研究以确定是否存在医学并发症。作为一个独立于她的 Susac 综合征的实体。皮质类固醇的使用或突然停药会导致被低估的诱发抑郁或躁狂症状的风险，这可能会暴露易感个体的情感障碍。许多医疗条件共享中枢神经系统受累和/或高剂量/长期皮质类固醇治疗。在这种情况下，躁狂或抑郁等精神症状应被视为继发性，并在考虑原发性精神疾病之前进行研究以确定是否存在医学并发症。