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Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review.
Am J Med Case Rep. 2019; 7(10):244-249.AJ

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31410363

Citation

Mehmood, Talha, et al. "Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: a Case Report and Literature Review." American Journal of Medical Case Reports, vol. 7, no. 10, 2019, pp. 244-249.
Mehmood T, Munir I, Abduraimova M, et al. Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review. Am J Med Case Rep. 2019;7(10):244-249.
Mehmood, T., Munir, I., Abduraimova, M., Ramirez, M. A., Paghdal, S., & McFarlane, I. M. (2019). Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review. American Journal of Medical Case Reports, 7(10), 244-249. https://doi.org/10.12691/ajmcr-7-10-6
Mehmood T, et al. Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: a Case Report and Literature Review. Am J Med Case Rep. 2019;7(10):244-249. PubMed PMID: 31410363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review. AU - Mehmood,Talha, AU - Munir,Irsa, AU - Abduraimova,Madina, AU - Ramirez,Miguel Antonio, AU - Paghdal,Sunny, AU - McFarlane,Isabel M, Y1 - 2019/07/31/ PY - 2019/8/15/entrez PY - 2019/8/15/pubmed PY - 2019/8/15/medline KW - aquaporin 4 antibodies KW - autoimmune disease KW - longitudinal extensive transverse myelitis KW - neuromyelitis optica spectrum disorders KW - seronegative NMOSD KW - systemic lupus erythematosus KW - transverse myelitis SP - 244 EP - 249 JF - American journal of medical case reports JO - Am J Med Case Rep VL - 7 IS - 10 N2 - 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. SN - 2374-216X UR - https://www.unboundmedicine.com/medline/citation/31410363/Longitudinally_Extensive_Transverse_Myelitis_Associated_With_Systemic_Lupus_Erythematosus:_A_Case_Report_and_Literature_Review L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31410363/ DB - PRIME DP - Unbound Medicine ER -
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