Transverse myelitis affecting more than 4 spinal segments associated with systemic lupus erythematosus: clinical, immunological, and radiological characteristics of 22 patients.
OBJECTIVE
To analyze the clinical and laboratory characteristics and outcomes of patients with transverse myelitis affecting more than 4 spinal segments secondary to systemic lupus erythematosus (SLE).


METHODS
A computer-assisted (PubMed) search of the literature was performed to identify all cases of transverse myelitis affecting more than 4 spinal segments secondary to SLE from 1966 to April 2008. In addition, we present 2 previously unreported cases of SLE patients with transverse myelitis affecting more than 4 spinal segments.


RESULTS
Twenty-two SLE patients with transverse myelitis affecting more than 4 spinal segments were finally reviewed. There were 17 (77%) females and the mean age at the diagnosis of myelitis was 29.3 +/- 9.4 years (range, 12-53 years). It was the first manifestation of SLE in 5 (23%) patients. The most frequent clinical manifestations were sensory deficit in 20 (91%) patients, variable motor deficit in 19 (86%), and urinary sphincter dysfunction in 15 (83%) patients. On magnetic resonance imaging, all patients showed increased T2 signal intensity of the spinal cord, most frequently in the cervical to mid-lower thoracic spinal segments. Most patients received a combination of therapies; corticosteroids and cyclophosphamide was the most common (45%). Three patients (14%) had complete resolution of symptoms and 14 (59%) had partial recovery.


CONCLUSIONS
Transverse myelitis affecting more than 4 spinal segments is a rare complication in patients with SLE but may be the first clinical manifestation of the disease in some patients. A high proportion of affected patients have variable degrees of disability after treatment.
Espinosa
Gerard
G
Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain. gespino@clinic.ub.es
Mendizábal
Andrea
A
Mínguez
Sonia
S
Ramo-Tello
Cristina
C
Capellades
Jaume
J
Olivé
Alejandro
A
Cervera
Ricard
R
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000276:immunology*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D003520:Cyclophosphamide; D008775:Methylprednisolone