Abstract
BackgroundLupus myelitis is a rare but disastrous complication of systemic lupus erythematosus (SLE). The transverse myelitis (TM) may involve three or more contiguous spinal cord segments and as such is designated longitudinally extensive transverse myelitis (LETM). The neurological presentation may vary based on the location of the pathology and may consist of a combination of sensory and motor deficits. TM could be the presenting feature of SLE or present after 10 years of disease, while SLE was considered to be in remission.Case presentation26-year-old Black man with history of biopsy proven-lupus nephritis that had progressed to ESRD, presented with sudden onset quadriplegia that resolved upon arrival to the hospital. On exam, the temperature was 101.8°F and the neurological exam was consistent with residual weakness on the left sided-upper and lower extremities. Leukopenia, lymphopenia and thrombocytopenia, along with low complements were noted. Brain MRI was normal however, the spine MRI was suspicious for an epidural process (C2-T4) and intravenous antibiotics were commenced. After five days, neurological improvement was nil and new spine MRI revealed spinal cord edema secondary to myelitis at several spinal cord levels (C2-T4). Laboratory data was consistent with a SLE flare complicated with longitudinal extensive transverse myelitis. Pulse steroids and plasma exchange were initiated. Two weeks after admission, MRI demonstrated resolution of the epidural spinal lesion and marked improvement in spinal cord edema.ConclusionTM can be the presenting feature of SLE or appear later on during the course of their disease. LETM is the most frequently type of TM found among SLE patients. Given the grave nature of the disease, it is of paramount importance that clinical features of TM be promptly recognized among SLE patients, to prevent catastrophic or even life-threatening outcomes.
Highlights
Lupus myelitis is a very rare but serious complication of systemic lupus erythematosus (SLE)
Transverse myelitis can present in the form of a longitudinally extensive transverse myelitis (LETM), which is defined as myelitis affecting three or more contiguous segments of the spinal the cord [5]
We present a case of LETM that occurred in a patient with SLE diagnosis which manifested as sudden onset quadriplegia
Summary
Lupus myelitis is a very rare but serious complication of systemic lupus erythematosus (SLE). Neurological manifestations are reported in up to 60% of patients with SLE these most commonly include stroke syndromes, seizures and peripheral neuropathies [1,2]. 1-2% of patients with SLE develop lupus myelitis [3,4]. Transverse myelitis can be complete or partial. Transverse myelitis can present in the form of a longitudinally extensive transverse myelitis (LETM), which is defined as myelitis affecting three or more contiguous segments of the spinal the cord [5]. We present a case of LETM that occurred in a patient with SLE diagnosis which manifested as sudden onset quadriplegia
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
