Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases

Abstract

To describe and compare the diagnosis, demographics and management of systemic lupus erythematosus (SLE) related versus idiopathic acute transverse myelitis during the initial presentation of the disease. We undertook a chart review of the hospital records of patients admitted to our hospital from 1994 until 2007 and had the diagnosis of SLE related and idiopathic acute transverse myelitis. Demographics, laboratory and imaging studies, diagnosis and treatment were recorded in both groups and analyzed in a case control fashion. We identified 15 patients with SLE-related acute transverse myelitis (SLE-ATM) and 39 idiopathic (I-ATM) cases between 1994 and 2007. Patients with SLE were more likely to be African American, have CNS demyelinating lesions on MRI, a high IgG% on their CSF analysis and a higher sedimentation rate on presentation. Treatment with high-dose steroids was instituted in both groups of patients, though SLE patients had a longer hospital stay by an average of 5 days. SLE-ATM patients were more likely to be African American as compared to I-ATM patients, have CNS demyelinating lesions on MRI, a high IgG% on CSF analysis and a higher sedimentation rate on presentation. The hospital stay for SLE patients was 5 days longer than the idiopathic patients. This study underlines the importance of early diagnosis of patients who develop ATM related to SLE.

Myelitis in systemic lupus erythematosus: clinical features, immunological profile and magnetic resonance imaging of five cases

“…Myelitis is one of these syndromes and may be the initial SLE manifestations (60% in our series), though myelitis also occur many year after SLE diagnosis. [4][5][6][7][8][9][10][11][12][13][14] We estimated the prevalence of myelitis in SLE at 2.1%, in line with previous reports. 4 The clinical presentation may be hyperacute, acute or subacute with motor impairment, sensory level and sphincter disturbances.…”

“…4 Although SLE-related myelitis is traditionally regarded as a single diagnostic entity, case reports and cohort studies show clinical and probably physiopathogenic heterogeneity. [4][5][6][7][8][9][10][11][12][13][14] The aim is to communicate and analyze an original series of SLE-related myelitis observed consecutively in a general hospital in Buenos Aires, Argentina.…”

Neuropsychiatric Lupus in clinical practice

“…Underlying pathophysiological mechanisms are not yet known. Histopathology findings have revealed ischemic/thrombotic myelopathy (especially in acute cases) or localized acute inflammation 44 . Systemic lupus erythematosus myelitis has two distinct clinical patterns: gray-matter and white-matter myelitis.…”

“…Lupus myelitis occurs in 1% to 1.5% of cases 44 . It manifests as transverse myelitis or asymmetrical spinal cord syndrome with hemiparesis, tetraparesis, bladder involvement, neuropathic pain, and presence of a sensory level.…”

“…It manifests as transverse myelitis or asymmetrical spinal cord syndrome with hemiparesis, tetraparesis, bladder involvement, neuropathic pain, and presence of a sensory level. Acute transverse myelitis is the first clinical manifestation in nearly half of the patients with SLE and it usually occurs within the first five years after diagnosis 44 . Underlying pathophysiological mechanisms are not yet known.…”