Transverse myelitis as a first manifestation of systemic lupus erythematosus: a case report

Transverse myelitis as a first manifestation of systemic lupus erythematosus (SLE) is very uncommon. No pathognomonic clinical or biochemical characteristics exist, and therefore an early diagnosis is often difficult. Therapy with intravenous pulses of methylprednisolone and cyclophosphamide has been shown to improve the prognosis. However, morbidity and mortality rates in transverse myelitis are still high due to the fact that complications such as opportunistic infections and pulmonary embolism are still frequent causes of death. We report a woman with relapsing transverse myelitis which was the first manifestation of SLE. A good response to pulse methylprednisolone and cyclophosphamide therapy was obtained but she died later as a result of a pulmonary embolism. We conclude that intravenous pulse methylprednisolone and cyclophosphamide therapy improve the prognosis of transverse myelitis associated with SLE but that a careful follow-up is needed to avoid complications due to the illness itself or secondary to the therapy.