daily psychosocial stressors interfere with the dynamics of urine neopterin in a patient with systemic lupus erythematosus an integrative singlecase study objective systemic lupus erythematosus sle is a chronic autoimmune disease characterized by flareups the causes of which are not known in accordance with new concepts in stress research this study investigated whether daily psychosocial stressors interfere with immunological processes in sle because such processes are unique to each individual singlecase design using timeseries analysis box and jenkins was appliedmethods a 40yearold woman with sle last flareup september 1995 was interviewed initially to determine major life events and difficulties using the life events and difficulties schedule in the previous 2 years she was then observed for 63 days urine neopterin an immunological parameter demonstrated to parallel disease activity in sle patients was measured in daily overnight urine daily incidents were identified weekly by the incidents and hassles inventory and independently rated intervening factors including infections medication and lifestyle were controlledresults retrospectively data obtained from the life events and difficulties schedule indicated that major life events and difficulties had preceded the patients last flareup in 1995 although there were no clinical signs of sle during this prospective study of 63 days crosscorrelational analyses revealed that moderately stressful incidents associated with higher levels of emotional irritation lag 0 0271 p 05 predicted an increase in urine neopterin the following day lag 1 0441 p 05 moreover a 7day cyclicity in neopterin levels that corresponded to the weekly examinations and interviews was foundconclusions this study showed a causal relationship between psychosocial stressors and urine neopterin concentrations that may be related to sle disease activity furthermore the workability of an integrative approach using singlecase design and timeseries analysis in psychoneuroimmunology was demonstrated for the first time