Systemic lupus erythematosus (SLE) is an autoimmune disease with the involvement of various systems. Neuropsychiatric symptoms of SLE (NPSLE) are nonspecific. The attribution of NP symptoms is difficult. We report a case with NP symptoms followed up for more than 20 years which tested positive for SLE. Introduction: SLE is a chronic autoimmune disease that is known to affect different organs in the body.¹ The diagnostic criteria of the disease have evolved over time, and the prevalence of the illness has also gradually increased. Nervous system involvement is common and can manifest as neurological or NP symptoms. The American College of Rheumatology has set definitions for 19 NP syndromes [12 central nervous system (CNS) and 7 peripheral nervous system (PNS)] deemed to occur in SLE, which is widely used in clinical practice and for research.¹ These NP syndromes are classified into frequent, common, infrequent, and rare based on the frequency of the symptoms.² None of the NP syndromes is specific for SLE; however, one-third of the NP syndromes are related to SLE autoimmunity.² Determination and attribution of NP syndromes to SLE in patients is a challenging but critical step in treatment.² Among psychiatric syndromes, mood disorder and anxiety have been found to be frequent compared with psychosis, which is infrequent.³