Systemic lupus erythematosus related transverse myelitis presenting longitudinal involvement of the spinal cord.
Lupus-related transverse myelitis is a rare but serious complication. A 25-year-old Japanese woman with systemic lupus erythematosus (SLE) was admitted because of numbness of the face and left upper extremity, headache, and intermittent fever. Six days later, she developed tetraplegia. MRI of the spinal cord showed longitudinal high intensity signals from medulla oblongata to C5, and from Th12 to conus medullaris on T2-weighted image. These MRI findings were consistent with acute catastrophic neurological abnormalities. Despite administration of the combination of methylprednisolone and cyclophosphamide pulse therapies, as well as plasmapheresis, her condition did not improve. Any vasculopathy in addition to the autoimmune pathogenesis, and narrow therapeutic window may relate to the present refractory case.
Kimura
Kato Yu-ko
KY
First Department of Internal Medicine, Nippon Medical School, Tokyo. kimuchi@gk9.so-net.ne.jp
Seino
Yoshihiko
Y
Hirayama
Yoshiyuki
Y
Aramaki
Takumi
T
Yamaguchi
Hiroshi
H
Amano
Hiroyuki
H
Takano
Teruo
T
D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D001379:Azathioprine / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004351:Drug Resistance; D005155:Facial Nerve Diseases / Q000209:etiology; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use; D011782:Quadriplegia / Q000209:etiology; D013116:Spinal Cord / Q000473:pathology*; D016055:Urinary Retention / Q000209:etiology
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D001379:Azathioprine; D008775:Methylprednisolone