Simultaneous central and peripheral nervous system involvement in systemic lupus erythematosus.
Systemic lupus erythematosus is a frequent autoimmune disease, affecting several organs, including the brain, spinal cord and nerves. Cerebral vasculitis, transverse myelitis and polyneuropathy are the most common neurological manifestations. We report a case of a 46 years old woman who suffered incomplete transverse myelitis at the age of 44. After 2 years the second relapse presented with arthralgias, painful paraesthesias and weakness of the lower limbs. Neurological signs suggested involvement of the central and the peripheral nervous system. Based upon clinical and laboratory findings systemic lupus erythematosus was diagnosed. Magnetic resonance imaging revealed two hyperintense lesions on T2 weighted scans within the cervical spinal cord. The brain scan was normal. Protein content was slightly elevated in the cerebrospinal fluid, with normal cell count. Electrophysiological examinations diagnosed a subacute sensory-motor axonal polyneuropathy. On methylprednisolone treatment her condition improved. Simultaneous development of central and peripheral lesions of the nervous system in cases with systemic lupus erythematosus may lead to a challenge to establish the diagnosis.
Ilniczky
Sándor
S
Semmelweis University, Department of Neurology, Budapest. sandor@neur.sote.hu
Kamondi
Anita
A
Arányi
Zsuzsanna
Z
Várallyay
György
G
Gaal
Barbara
B
Szirmai
Imre
I
Nagy
György
G
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D002490:Central Nervous System / Q000503:physiopathology*; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D018908:Muscle Weakness; D009187:Myelitis / Q000209:etiology; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010292:Paresthesia / Q000209:etiology; D017933:Peripheral Nervous System / Q000503:physiopathology*; D011115:Polyneuropathies / Q000209:etiology
D000893:Anti-Inflammatory Agents; D018696:Neuroprotective Agents; D008775:Methylprednisolone