Steroid resistant recurrent transverse myelitis in an elderly female with good response to plasma pheresis: A case report

Abstract

Transverse myelitis is a rare disease involving inflammation of the spinal cord. It is estimated to have an incidence of 1.34 to 4.6 per million. It is more common in females and has a bimodal peak at 10–19 years old and 30–39 years old. It is monophasic but may become recurrent in some. Diagnostic criteria for the spectrum of diseases involving transverse myelitis is still evolving. Studies have shown an association between recurrent transverse myelitis, neuromyelitis optica spectrum and autoimmune antibodies associated with systemic lupus erythematosus (SLE) and other systemic autoimmune conditions. Management options for recurrent transverse myelitis include steroids, plasmapheresis, immunosuppressive antimetabolites and monoclonal antibody. We are presented now with an interesting case of recurrent transverse myelitis in an elderly female presenting with progressive weakness and numbness of the bilateral lower extremities. She tested positive for autoimmune antibodies anti-ssA and anti-dsDNA. She had disease progression despite management with intravenous steroids, hence was considered steroid-resistant. The patient responded well with six sessions of plasmapheresis.