Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review
| Autor: | Sunny Paghdal, Madina Abduraimova, Isabel M. McFarlane, Irsa Munir, Miguel Ramirez, Talha Mehmood |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Myelitis autoimmune disease Transverse myelitis Article Lesion 03 medical and health sciences 0302 clinical medicine transverse myelitis systemic lupus erythematosus Biopsy Medicine skin and connective tissue diseases General Environmental Science 030203 arthritis & rheumatology Systemic lupus erythematosus Leukopenia medicine.diagnostic_test business.industry longitudinal extensive transverse myelitis medicine.disease Spinal cord seronegative NMOSD 3. Good health aquaporin 4 antibodies medicine.anatomical_structure General Earth and Planetary Sciences Radiology medicine.symptom neuromyelitis optica spectrum disorders business Complication 030217 neurology & neurosurgery |
| Zdroj: | American journal of medical case reports |
| ISSN: | 2374-216X 2374-2151 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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