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Optic neuritis and recurrent myelitis in a woman with systemic lupus erythematosus
Julius Birnbaum1, Douglas Kerr
1Division of Rheumatology, The Johns Hopkins University of Medicine, Baltimore, MD 21224, USA. jbirnba2@jhmi.edu
Background:
A 38-year-old woman with systemic lupus erythematosus presented with headaches and bilateral hearing loss. Brain MRI was initially suggestive of small-vessel disease developing in the context of neuropsychiatric systemic lupus erythematosus. Several months later, the patient developed optic neuritis, followed by recurrent attacks of myelitis.
Investigations:
MRI of the spine revealed multifocal regions of myelitis affecting the cervical spine. Serological evaluation revealed the presence of neuromyelitis optica-IgG antibodies. MRI of the brain was nondiagnostic for multiple sclerosis.
Diagnosis:
Recurrent myelitis and optic neuritis, occurring in the context of neuromyelitis optica (also known as Devic's syndrome).
Management:
The patient had recurrent attacks of myelitis despite treatment with pulse cyclophosphamide. After initiation of rituximab, the patient experienced symptomatic improvement and had no further attacks of opticospinal disease.
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