Systemic lupus erythematosus presented as extensive longitudinal myelitis

Area of Science:

• Neurology
• Immunology
• Rheumatology

Background:

• Longitudinal myelitis (LM) involves continuous spinal cord lesions exceeding four segments.
• LM is a rare, severe variant of acute transverse myelitis with poor treatment response.
• Systemic lupus erythematosus (SLE) can present with rare neurological complications like LM.

Purpose of the Study:

• To report a unique case of acute longitudinal myelitis.
• To investigate the association between newly diagnosed SLE and extensive spinal cord lesions.
• To highlight the diagnostic challenges and potential severity of SLE-associated LM.

Main Methods:

• Case presentation of a 39-year-old male with acute urinary retention and lower limb weakness.
• Neurological examination revealing upper limb hyperreflexia and lower limb hyporeflexia.
• Spinal MRI demonstrating extensive T2WI hyperintensity from cervical to conus medullaris.
• Diagnosis of SLE based on ARA criteria, excluding NMO and MS.

Main Results:

• The patient presented with progressive lower limb weakness and sensory deficits.
• Spinal MRI revealed extensive longitudinal myelitis involving the cervical cord to the conus medullaris.
• The patient was diagnosed with newly diagnosed SLE as the cause of LM.

Conclusions:

• SLE can cause severe longitudinal myelitis with extensive spinal cord involvement.
• LM associated with SLE often has a poor prognosis and leads to disabling sequelae.
• Further research is needed to understand the disease course, mechanisms, and optimal treatment for SLE-associated LM.