Longitudinal myelitis, aseptic meningitis, and conus medullaris infarction as presenting manifestations of pediatric systemic lupus erythematosus.
A healthy boy developed subacutely progressive quadriparesis, complicated by sudden paraplegia, fever, and meningeal signs, diagnosed as longitudinal myelitis, aseptic meningitis, and conus medullaris infarction and identified as the presenting manifestations of neuropsychiatric systemic lupus erythematosus. Rapid expansion of the conus on serial neuroimaging led to emergent decompressive laminectomy and cord biopsy showing vasculitis and cord infarction. The patient had partial recovery after treatment with high-dose steroids. Increased vigilance is required when pediatric patients develop a similar subacute presentation on the ground of active systemic lupus erythematosus because it may herald the onset of a catastrophic neurological syndrome.
Katramados
A M
AM
Department of Neurology, Henry Ford Hospital, Detroit, Michigan 48202, USA. angelo@neuro.hfh.edu
Rabah
R
R
Adams
M D
MD
Huq
A H M M
AH
Mitsias
P D
PD
D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007796:Laminectomy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000209:etiology*; D009187:Myelitis / Q000175:diagnosis / Q000209:etiology*; D013116:Spinal Cord / Q000098:blood supply*; D013117:Spinal Cord Compression / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013904:Thoracic Vertebrae