title: Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up.
abstract: Transverse myelitis (TM) with systemic lupus erythematosus (SLE) has been linked to the presence of autoantibodies (eg, antiaquaporin 4 (AQP4) and anticardiolipin (aCL)) and SLE-induced secondary vasculitis, but the aetiology remains incompletely understood. A 48-year-old Japanese man with a 6-year history of poorly controlled SLE had stopped glucocorticoid therapy 1 year before admission. 3 days before admission, he developed flaccid paraplegia. Spinal MRI showed a longitudinally hyperintense T2 grey matter lesion from the level of Th4 to the conus medullaris, which was considered longitudinally extensive TM (LETM). We administered steroid pulse therapy (methyl-prednisolone 1000 mg/day) for 3 days and prednisolone 50 mg/day. The patient's flaccid paralysis gradually improved. We concluded that the patient's TM was caused by SLE flare-up, even though we could not completely rule out antiphospholipid syndrome. SLE myelitis is relatively rare and many aetiologies are possible for TM in SLE.
authors.affiliation: Department of Neurology, Osaki Citizens' Hospital, Osaki, Japan.
authors.forename: Kentarou
authors.initials: K
authors.lastname: Takei
authors.affiliation: Department of Neurology, Osaki Citizens' Hospital, Osaki, Japan.
authors.forename: Mineshige
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Neurology, Osaki Citizens' Hospital, Osaki, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Neurology, Osaki Citizens' Hospital, Osaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D001323:Autoantibodies / Q000032:analysis*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate