Myelitis in systemic lupus erythematosus: six cases report and review of the literature

Abstract

Objective To analyze the clinical features of myelitis in systemic lupus erythematosus (SLE). Methods The clinical features, laboratory examinations, treatment and prognosis of 6 patients with myelopathy in SLE were described. Results The median onset age of the 6 patients was (38±12) years old (20-52 years of age). The mean duration from symptom onset of SLE to myelitis was 29 months (1 month to 5 years). All patients had lower limb hypodynamia. In 3 cases with longitudinal myelitis (LM), the involved lesions of the spine were more than four segments. Two patients presented with neurological manifestations as the first symptom of SLE. Magnetic resonance imaging (MRI) showed longitudinal or speckle lesions. The lesions of the spine were located at the thoracic region in 5 cases. Four patients had cervical spinal cord involvement. The specific laboratory parameters included anti-phospholipid antibody (positive in 3 cases) and low glucose level in cerebral spinal fluid (3 cases, all of them were LM). All patients were treated with i.v. pulses methylprednisolone and cyclosphosphamide. The good response to treatment was achieved in all 3 cases with transverse myefitis(TM). Three cases with LM had poor prognosis, 2 cases relapsed after three months, 1 case showed no improvement at all. Conclusion Transverse and longitu-dinal myelitis are two forms of myelitis in SLE. The presence of aPL and low glucose level in cerebral spinal fluid can be associated with LM. The prognosis of LM is poor. Key words: Lupus erythematosus, systemic; Myelitis; Disease Attributes