Andrzej Banyś, Jakub Kaźmierski, Ryszard Jaszewski independently predisposing to delirium or psychotic disorders after cardiac surgery. It was proved, though, that increased cortisol levels independently enhance delirium risk after operations other than cardiac surgery [10]. Moreover, MMF administered to the patient could contribute to delirium, especially when combined with another immunosuppressive agent (prednisone). However, the use of MMF was reported as more effective and safer than other immunosuppressants in SLE with neuropsychiatric complications [11]. The originality of the current case report consists in coincidence of three factors which contributed to delirium in a single patient: cardiac surgery, SLE and steroid therapy. To our knowledge, such a case report has not been presented in the available literature. Occurrence of postoperative neuropsychiatric complications deteriorates the prognosis, lengthens the patient’s stay at the ICU and the overall hospitalization time, and also increases the frequency of institutionalization after hospital discharge [12]. The presented data show that patients with Systemic lupus erythematosus constitute a risk group of postoperative mental disorders (psychotic ones, especially). SLE patients scheduled for intervention should then be monitored particularly in the perioperative period for delirium and psychotic disorders. Such tools as the Memorial Delirium Assessment Scale, or Delirium Index, standardized in cardiac surgery patient groups, can be applied [13]. R e f e r e n c e s 1. Mc Cune WJ, Golbus J. Neuropsychiatric lupus. Rheum Dis Clin North Am 1988; 14: 149-67. 2. Hanly JG, Liang MH. Cognitive disorders in systemic lupus erythematosus: epidemiologic and clinical issues. Ann NY Acad 1997; 823: 60-8. 3. Kassan SS, Lockshin MD. Central nervous system lupus erythematosus: the need for classification. Arthritis Rheum 1979; 22: 1382-5. 4. ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature. The American College of Rheumatology Nomenclature and Case Definitions for Neuropsychiatric Lupus Syndromes. Arthritis Rheum 1999; 42: 599-608. 5. Kazmierski J, Kowman M, Banach M, et al. Preoperative predictors of delirium after cardiac surgery: a preliminary study. Gen Hosp Pschychiatry 2006; 26: 536-8. 6. Kazmierski J, Kowman M, Banach M, et al. Incidence and predictors of delirium after cardiac surgery: results from IPDACS Study. J Psychosom Res 2010; 69: 179-85. 7. Pego-Reigosa JM, Isenberg DA. Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease. Rheumatology (Oxford) 2008; 47: 1498-502. 8. Gitay EJ, Huijskes RV, Kho KH, Blansjaar BA, Rosseel PM. Psychotic symptoms in patients undergoing coronary artery bypass grafting and heart valve operation. Eur J Cardiothorac Surg 2006; 30: 140-7. 9. Banach M, Kazmierski J, Kowman M, et al. Atrial fibryllation as a nonpsychiatric predictor of delirium after cardiac surgery: a pilot study. Med Sci Monit 2008; 14: CR286-91. 10. McIntosh TK, Bush HL, Teston NS, et al. Beta-endorfin, cirtisol and postoperative delirium: a preliminary report. Psychoneuroendocrinology 1985; 10: 303-13. 11. Jose J, Paulose BK, Vasuki Z, Danda D. Mycophenolate mofetil in neuropsychiatric systemic lupus erythematosus. Indian J Med Sci 2005; 59: 353-6. 12. Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: Effect of beating- heart (off-pump) surgery. J Thorac Cardiovasc Surg 2004; 127: 57-64. 13. Kazmierski J, Kowman M, Banach M, et al. The use of DSM-IV and ICD-10 criteria and diagnostic scales for delirium among cardiac surgery patients: results from IPDACS Study. J Neuropsychiatry Clin Neurosci 2010; 22: (in press). 344 Arch Med Sci 2, April / 2011