Transverse Myelitis Affecting More Than 4 Spinal Segments Associated With Systemic Lupus Erythematosus: Clinical, Immunological, and Radiological Characteristics of 22 Patients

Semin Arthritis Rheum. 2010 Feb;39(4):246-56. doi: 10.1016/j.semarthrit.2008.09.002. Epub 2008 Nov 20.

Abstract

Objective: To analyze the clinical and laboratory characteristics and outcomes of patients with transverse myelitis affecting more than 4 spinal segments secondary to systemic lupus erythematosus (SLE).

Methods: A computer-assisted (PubMed) search of the literature was performed to identify all cases of transverse myelitis affecting more than 4 spinal segments secondary to SLE from 1966 to April 2008. In addition, we present 2 previously unreported cases of SLE patients with transverse myelitis affecting more than 4 spinal segments.

Results: Twenty-two SLE patients with transverse myelitis affecting more than 4 spinal segments were finally reviewed. There were 17 (77%) females and the mean age at the diagnosis of myelitis was 29.3 +/- 9.4 years (range, 12-53 years). It was the first manifestation of SLE in 5 (23%) patients. The most frequent clinical manifestations were sensory deficit in 20 (91%) patients, variable motor deficit in 19 (86%), and urinary sphincter dysfunction in 15 (83%) patients. On magnetic resonance imaging, all patients showed increased T2 signal intensity of the spinal cord, most frequently in the cervical to mid-lower thoracic spinal segments. Most patients received a combination of therapies; corticosteroids and cyclophosphamide was the most common (45%). Three patients (14%) had complete resolution of symptoms and 14 (59%) had partial recovery.

Conclusions: Transverse myelitis affecting more than 4 spinal segments is a rare complication in patients with SLE but may be the first clinical manifestation of the disease in some patients. A high proportion of affected patients have variable degrees of disability after treatment.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Antirheumatic Agents / therapeutic use
  • Child
  • Cyclophosphamide / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / immunology
  • Magnetic Resonance Imaging
  • Male
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Myelitis, Transverse / drug therapy
  • Myelitis, Transverse / etiology*
  • Myelitis, Transverse / immunology
  • Retrospective Studies
  • Spinal Cord / immunology*
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Glucocorticoids
  • Cyclophosphamide
  • Methylprednisolone