SHM Converge Scientific Abstract ePoster Gallery-Transverse Myelitis in Systemic Lupus Erythematosus

Pdf Summary

This case describes a 25-year-old woman who presented with one month of intermittent fever and headache, followed by two days of sudden bilateral lower-limb sensorimotor weakness and sphincter dysfunction. She had no trauma, back pain, neck stiffness, or loss of consciousness, and had been treated with glucocorticoids for a prior diagnosis of rheumatoid arthritis.<br /><br />On examination, she had flaccid paraplegia with 0/5 power and tone in both legs, absent knee, ankle, and plantar reflexes, and reduced pain, touch, and proprioception. Laboratory workup showed low complement levels, positive ANA, and multiple lupus-associated antibodies including anti-dsDNA, nucleosome, Sm/RNP, and SSA/Ro. Aquaporin-4 and MOG antibodies were negative, and cerebrospinal fluid did not show oligoclonal bands.<br /><br />MRI of the spine demonstrated long-segment T2 hyperintensities extending from T2 to the conus medullaris, with involvement of the medulla oblongata and no post-gadolinium enhancement, consistent with transverse myelitis. The overall picture supported neuropsychiatric/systemic lupus erythematosus rather than demyelinating disease such as neuromyelitis optica.<br /><br />She was treated with a 5-day course of intravenous methylprednisolone, but did not improve. Plasma exchange was then performed for five cycles, and cyclophosphamide was started. Unfortunately, she later died from severe ARDS.<br /><br />The report emphasizes that transverse myelitis is a rare but serious complication of SLE, affecting about 1–2% of patients, and can cause motor, sensory, autonomic, and neuropsychiatric deficits. It highlights the importance of early recognition and urgent treatment with high-dose corticosteroids, often combined with cyclophosphamide, especially in gray matter myelitis, which typically presents with flaccid paralysis.

Asset Subtitle

Aditya Shah

Meta Tag

Author List Aditya Shah, Akhil Nagrani, Harshvardhan Zala, Kush Trivedi, Rachit Shah, Urvish Patel

Category Clinical Vignettes

Concept Transverse Myelitis

Concept Systemic Lupus Erythematosus

Concept Lower Extremity Weakness

Concept High-Dose Corticosteroid

Concept Neuroinflammatory Complication

Distinguished Non-Finalist

Presenter Organization B.J. Medical College, Ahmedabad, Gujarat, India 380016

Presenting Author Aditya Shah

Track Adult

Keywords

systemic lupus erythematosus

transverse myelitis

flaccid paraplegia

sensorimotor weakness

sphincter dysfunction

MRI spine

anti-dsDNA

plasma exchange

cyclophosphamide

high-dose corticosteroids

Transverse Myelitis

Systemic Lupus Erythematosus

Lower Extremity Weakness

High-Dose Corticosteroid

Neuroinflammatory Complication