Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review

Talha Mehmood¹, Irsa Munir¹, Madina Abduraimova¹, Miguel Antonio Ramirez¹, Sunny Paghdal¹ and Isabel M. McFarlane^1,

¹Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203 USA

Cite this paper

Talha Mehmood, Irsa Munir, Madina Abduraimova, Miguel Antonio Ramirez, Sunny Paghdal and Isabel M. McFarlane. Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review. American Journal of Medical Case Reports. 2019; 7(10):244-249. doi: 10.12691/AJMCR-7-10-6

Abstract

Background: Lupus 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 presentation: 26-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. Conclusion: TM 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.

Keywords

systemic lupus erythematosus, transverse myelitis, longitudinal extensive transverse myelitis, neuromyelitis optica spectrum disorders, aquaporin 4 antibodies, seronegative NMOSD, autoimmune disease

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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