Extensive longitudinal lupic myelitis: A case report with a literature review

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that may present with a wide range of clinical manifestations, including neurological involvement. Transverse myelitis (TM) is a well-known but rare manifestation of SLE, typically affecting the cervical, thoracic, or lumbar regions of the spinal cord. However, longitudinal myelitis (LM), which extends across more than 4 spinal segments, is exceedingly rare in the context of SLE. Here, we report a case of extensive longitudinal myelitis in a 47-year-old female with a history of SLE presenting with progressive lower limb weakness, sensory disturbances, and sphincter dysfunction. The magnetic resonance imaging (MRI) of the spinal cord revealed hypersignal abnormalities on T2-weighted sequences extending from the cervical spine to the conus medullaris. The patient was treated with high-dose intravenous methylprednisolone, followed by oral prednisone and cyclophosphamide. She showed gradual improvement with resolution of effusions and partial neurological recovery. This case underscores the importance of recognizing longitudinal myelitis as a rare but significant manifestation of SLE, emphasizing the need for early intervention and comprehensive management strategies.