Nineteen episodes of recurrent myelitis in a woman with neuromyelitis optica and systemic lupus erythematosus.
OBJECTIVE
To describe the case of a patient with systemic lupus erythematosus (SLE) and neuromyelitis optica (NMO) who experienced 19 recurrent attacks of myelitis.


METHODS
Case report.


METHODS
An outpatient neurorheumatology clinic at the Johns Hopkins Hospital devoted to care of patients with neurological manifestation of rheumatic diseases. Patient A woman with NMO and SLE. Intervention Rituximab therapy.


METHODS
Clinical and neuroimaging features of relapsing disease.


RESULTS
Recurrent and increasingly severe myelitis attacks still occurred after treatment with rituximab.


CONCLUSIONS
It may be progressively more difficult to prevent relapses and commensurate disability in patients with later stages of relapsing NMO. Recognition of NMO as a distinct diagnostic entity in patients with SLE and other rheumatic diseases is crucial, in that institution of earlier targeted immunosuppressant treatment may be more effective than later targeted immunosuppression. The cellular arm of the immune system may be recruited by pathogenic B cells and may explain why relapses may occur after treatment with B cell-depleting therapy.
Nasir
Sajjad
S
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Kerr
Douglas A
DA
Birnbaum
Julius
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001741:Black or African American; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D003520:Cyclophosphamide / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects / Q000276:immunology; D007113:Immunity, Innate; D007165:Immunosuppression Therapy / Q000379:methods / Q000592:standards; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D009471:Neuromyelitis Optica / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D000069283:Rituximab; D055502:Secondary Prevention; D013116:Spinal Cord / Q000187:drug effects / Q000276:immunology / Q000473:pathology
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D018501:Antirheumatic Agents; D000069283:Rituximab; D003520:Cyclophosphamide