title: Transverse myelitis as the first manifestation of systemic lupus erythematosus or lupus-like disease: good functional outcome and relevance of antiphospholipid antibodies.
abstract: OBJECTIVE
  Transverse myelitis (TM) is a rare complication of systemic lupus erythematosus (SLE). Although usually a late manifestation of SLE, it can occur at presentation. We investigated the clinical presentation, treatment and outcome of 15 patients with TM as the presenting manifestation of SLE or lupus-like disease.
  
  
  METHODS
  All patients received corticosteroids, while 13 also received immunosuppressive therapy. Five patients were fully anticoagulated with warfarin.
  
  
  RESULTS
  A sensory level with spastic lower limb weakness and sphincter disturbance was the most common presentation: 14/15 patients had a thoracic or cervical sensory level. Cerebrospinal fluid examination showed high protein concentrations in 3 patients and oligoclonal bands in 8. Eleven of the 15 (73%) had antiphospholipid antibodies (aPL). Of the 15 patients, 3 had complete resolution of the symptoms, 6 had good functional improvements, 5 had good to fair outcome with some functional deficit, and one patient who received corticosteroids alone later died from pneumonia.
  
  
  CONCLUSIONS
  We describe 15 patients with TM as the presenting manifestation of SLE or lupus-like disease with a high prevalence of aPL. Our data support the view that early diagnosis and immunosuppressive therapy may be superior to corticosteroids alone in improving functional outcome. In those patients with aPL, antiplatelet agents and/or warfarin should also be considered.
authors.affiliation: Louise Coote Lupus Unit, St. Thomas' Hospital, London; Rivermead Rehabilitation Centre, Oxford, United Kingdom. david.d'cruz@kcl.ac.uk
authors.forename: David P
authors.initials: DP
authors.lastname: D'Cruz
authors.forename: Susana
authors.initials: S
authors.lastname: Mellor-Pita
authors.forename: Beatriz
authors.initials: B
authors.lastname: Joven
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sanna
authors.forename: Judith
authors.initials: J
authors.lastname: Allanson
authors.forename: James
authors.initials: J
authors.lastname: Taylor
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: Graham R V
authors.initials: GR
authors.lastname: Hughes
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology
chemical_list: D017152:Antibodies, Antiphospholipid