Myelopathy in Systemic Lupus Erythematosus

Abstract

Acute myelitis is an inflammatory condition of the spinal cord that is characterized by neuronal and axonal damage, causing paralysis or paresis, sensory deficit and autonomic dysfunction. The incidence in the general population is 1 to 4 cases per million inhabitants per year. Diagnosis is based on clinical findings, laboratory tests, and the use of MRI.

We present the case of an 18-year-old female patient with a previous diagnosis of Systemic Lupus Erythematosus with renal involvement, initially treated with Cyclophosphamide and receiving maintenance with mycophenolate mofetil. The patient presented with muscle weakness in the lower limbs of 2 weeks' duration that progressed to paraplegia and sensory alteration with motor compromise, bladder and intestinal dysfunction. On physical examination, Achilles and patellar reflexes were abolished and anesthesia was administered from the T8 sensory level, and the patient was maintained with a urinary catheter. Laboratory data revealed elevated acute phase reactants and hypocomplementemia. SLEDAI 8 points. MRI was performed with evidence of a hyperintense lesion at the T6 level. The patient was treated with intravenous corticosteroids and Rituximab with partial clinical response in sensitivity and sphincter control, but without motor response.