[A case of systemic lupus erythematosus with various central and peripheral neurological disorders presenting with motor paralytic bladder as a major manifestation].
Myelopathy is a rare central nervous system manifestation in systemic lupus erythematosus (SLE). We present a case of SLE, who developed motor paralytic bladder and various other neurological abnormalities. A 29-year-old female with SLE was admitted to our hospital because of complete dysuria without any troubles on defecation. Accelerated hypertension had been noticed 2 weeks before the admission. Physical examinations revealed that she had muscle weakness in right brachial biceps, bilateral carpal extensor and flexor, and flexor muscles of bilateral lower extremities. Slight sensory disturbance was present on her soles. Bilateral Chaddok and Babinski's signs were positive. Electromyographic studies including nerve conduction velocities of her limbs were normal, however, neurogenic discharges were observed in anal sphincter muscles. Cystometry demonstrated atonic bladder, but any pathological findings such as lupus cystitis and interstitial cystitis were not observed in the biopsied specimens from her bladder. Antibodies to single-stranded DNA, U1 RNP, Sm and SS-A/Ro were positive in her serum, and lupus anticoagulant and anticardiolipin antibodies (IgG) were also detected. In her cerebral spinal fluid (CSF), elevated protein level and albuminocytologic dissociation were recognized, while glucose level was low. Magnetic resonance imaging (MRI) study detected high signal intensities in the inner part of medulla oblongata and in the spinal cord at second lumbar spine level. After two courses of methyl-prednisolone pulse therapy, the patient's neurological symptoms including dysuria had completely recovered and abnormal findings previously observed on MRI had also disappeared. After 7 months of the episode, she became normotensive. The proteins and glucose levels in her CSF had gradually returned to normal. Among patients with SLE, correlations of antiphospholipid antibodies with myelitis/myelopathy or accelerated hypertension have been reported. Therefore, possible roles of antiphospholipid antibodies were considered in the pathogenesis of neurologic abnormalities observed in our patient. In addition, low glucose level in CSF might be a good indicator for the diagnosis of lupus-associated myelopathy.
Horiki
T
T
Department of Internal Medicine IV, Tokai University School of Medicine, Kanagawa.
Moriuchi
J
J
Kouzuma
R
R
Haida
M
M
Watanabe
S
S
Katsuoka
Y
Y
Ichikawa
Y
Y
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D017152:Antibodies, Antiphospholipid; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008775:Methylprednisolone / Q000008:administration & dosage; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D001745:Urinary Bladder Diseases / Q000209:etiology*
D000893:Anti-Inflammatory Agents; D017152:Antibodies, Antiphospholipid; D008775:Methylprednisolone