Abstract
BackgroundCentral nervous system involvement is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE). Evidence-based treatment options are limited in neurolupus, especially in patients unresponsive to the first line therapeutic agents. Case reportWe report a 15-year-old girl who presented with subacute spastic quadriparesis along with constitutional features of SLE. She was bed bound at presentation with respiratory muscle weakness and bowel and bladder dysfunction. Magnetic resonance imaging showed intramedullary T2 -weighted hyperintensities involving the cervical and thoracolumbar spinal cord, brainstem and thalami. Neurological status worsened despite high dose pulse intravenous glucocorticoids, warranting second line therapy. She had rapid and complete improvement with therapeutic plasma exchange favoring its consideration as an efficacious treatment modality in lupus myelitis. We have further reviewed the literature on the use of therapeutic plasma exchange in lupus myelitis. ConclusionMyelitis is a rare but serious complication of SLE. Judicious use of therapeutic plasma exchange can be considered along with steroids for recovery and to avert the adverse effects of immunosuppression.
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