SHM Converge Scientific Abstract ePoster Gallery-Aquaporin-4 Positive Neuromyelitis Optica in a Patient With Sle Following Vaccination: A Case Report

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This case report describes a 31-year-old woman with systemic lupus erythematosus (SLE) who developed rapidly progressive neurologic symptoms after stopping mycophenolate and shortly after receiving shingles and pneumococcal vaccines. She presented with ascending numbness, weakness, urinary retention, and progressed to flaccid quadriparesis with severe sensory loss below the neck, without signs of an SLE flare.<br /><br />MRI of the spine showed a longitudinally extensive transverse myelitis lesion extending from the cervicomedullary junction through the thoracic cord, with patchy enhancement. Cerebrospinal fluid revealed marked pleocytosis and elevated protein, and both serum and CSF were positive for aquaporin-4 antibodies, confirming neuromyelitis optica spectrum disorder (NMOSD).<br /><br />The report emphasizes that NMOSD can coexist with SLE and may resemble lupus-associated myelitis, making early recognition essential. Because treatment and relapse risk differ, longitudinally extensive transverse myelitis in patients with SLE should prompt aquaporin-4 antibody testing. Rapid treatment with IV steroids, plasma exchange, and long-term immunotherapy is important to reduce the risk of irreversible neurologic disability.<br /><br />The patient was treated with 5 days of IV methylprednisolone, 7 sessions of plasma exchange, and rituximab for maintenance, then discharged to inpatient rehabilitation.

Asset Subtitle

Shane Fuentes

Meta Tag

Author List Nadir Bhuiyan, Shane Fuentes

Category Clinical Vignettes

Concept Neuromyelitis Optica Spectrum Disorder

Concept Longitudinally Extensive Transverse Myelitis

Concept Aquaporin-4 Antibody

Concept Spinal Cord Lesion

Concept Lupus-associated Myelitis

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Shane Fuentes

Track Adult

Keywords

systemic lupus erythematosus

neuromyelitis optica spectrum disorder

aquaporin-4 antibodies

longitudinally extensive transverse myelitis

mycophenolate discontinuation

shingles vaccine

pneumococcal vaccine

quadriparesis

plasma exchange

rituximab

Neuromyelitis Optica Spectrum Disorder

Longitudinally Extensive Transverse Myelitis

Aquaporin-4 Antibody

Spinal Cord Lesion

Lupus-associated Myelitis