[A case developing tetraplegia due to systemic lupus erythematosus which was remitted by a steroid]

The case reported here was a 58-year-old woman who was diagnosed as having systemic lupus erythematosus (SLE) in 1985 because she had erythema in the cheeks arthritis, a hematological abnormality (decreased white blood cell count), an immunological abnormality (LE-positive cells), and a positive result of antinuclear antibody test. Although the patient was once remitted by treatment with prednisolone (PSL) at 60 mg/day, and continuously received PSL at a maintenance dose of 2.5 mg/day, she was admitted in June 1996 by our hospital with chief complaints of fever and decreased muscular strength in the four extremities. At admission, she had symmetrical tetraplegia, which was peripherally predominant and severer in the lower extremities, and hypoesthesia accompanied by numbness. She was negative for anti-phospholipid antibody and showed no abnormality in cerebrospinal fluid examination. No lesions responsible for tetraplegia were detected at brain MRI, spinal MRI, or myelography. Because fever, multiple arthralgia, an increased erythrocyte sedimentation rate, a decreased lymphocyte count, hypocomplementemia, and a high immune complex level indicated the active stage of SLE (recurrence), she was given PSL at dose increased to 60 mg/day. After about 2 months, SLE was remitted and her tetraplegia and hypoesthesia was gradually improved thereafter. Although tetraplegia associated with peripheral nervous disorder, in which angitis occurring as a symptom of the active stage of SLE was thought to be Involved, was remitted by a steroid in out patient, no such cases have been reported in Japan, to our knowledge. Thus our patient was thought to be a very rare case of value.