"Great mimicry" in a patient with tetraparesis: a case report

The patient is a 63-year-old Chinese man who presented with tetraparesis and urinary incontinence. The initial diagnosis was cord compression from cervical spondylosis. The patient relapsed 3 months after cervical laminectomy. The transverse myelitis picture, left optic atrophy and suggestive brainstem evoked potentials led to treatment of a presumptive demyelinating process. The presence of vitiligo, however, led to detection of high titers of antinuclear antibodies (ANA) and presence of anti-nonhistone antibodies. The patient was then diagnosed to have a lupus (SLE)-like disease, which has not fully evolved. He was prescribed pulsed cyclophosphamide and prednisolone with significant gains both neurologically and functionally up to 1 year of follow-up. This report highlights the befuddling impact the disease process have on the clinicians in terms of diagnosis, treatment, and prognosis. That it can occur in men in the seventh decade of life heightens the need for awareness in our approach to the myelopathic patient.