title: Systemic lupus erythematosus related transverse myelitis presenting longitudinal involvement of the spinal cord.
abstract: 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.
authors.affiliation: First Department of Internal Medicine, Nippon Medical School, Tokyo. kimuchi@gk9.so-net.ne.jp
authors.forename: Kato Yu-ko
authors.initials: KY
authors.lastname: Kimura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Takumi
authors.initials: T
authors.lastname: Aramaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Amano
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D001379:Azathioprine; D008775:Methylprednisolone