High-titer Anti-aquaporin-4-IgG-associated Myelitis in Rhupus Syndrome: Figure 1.

Abstract

To the Editor: Severe organ damage, especially central nervous system (CNS) involvement, has rarely been reported in patients with rhupus syndrome (RS). Two recent articles in The Journal of Rheumatology 1,2 have discussed this condition, which is a challenge in rheumatology. A 51-year-old woman was referred to our center for longstanding polyarthralgia, fever, malaise, and malar rash associated with a history of neurological abnormalities. In 1999 the patient felt a sudden pain in her back between the shoulder blades and then developed weakness of the upper extremities and paresthesias at the lower ones. No urinary symptoms were found. During the physical examination a decrease of arm strength was recorded, and a loss of sense of touch and of pain from the nipples through the feet. Scans of T2-weighted sequences of magnetic resonance imaging (MRI) of the spine showed a hyperintense lesion involving the medulla from level C5 to T7. An MRI scan of the brain was normal. Examination of the cerebrospinal fluid showed a high protein content and pleocytosis. … Address correspondence to Dr. S. Sciascia, CMID, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord Emergenza San G. Bosco ed Università di Torino, Piazza del Donatore di Sangue 3, 10154 Turin, Italy. E-mail: savino.sciascia{at}unito.it