Lupus transverse myelopathy: better outcome with early recognition and aggressive high-dose intravenous...

Seven patients with transverse myelopathy (TM) were found to have systemic lupus erythematosus (SLE). Four patients had no prior diagnosis of SLE. All patients had positive antinuclear antibody (ANA). All patients had a spinal syndrome which progressed to TM with cervical or thoracic levels. The diagnosis of TM was confirmed with neurological tests and neuro-radiographic studies. Delay in diagnosis and treatment resulted in a poor outcome. Four patients died and one remained wheelchair-bound. Only two patients who received high-dose IV pulse steroid within 1 week of onset of TM had a good outcome, with full ability to ambulate without assistance. Our experience suggests that early diagnosis with early treatment using high-dose IV steroid affects the mortality and improves the outcome.