Acute Transverse Myelopathy as the Initial Manifestation of Probable Systemic Lupus Erythematosus in a Child

Abstract

A 10-year-old girl was presented with acute transverse myelopathy. She had three mild relapses within one year. Systemic lupus erythematosus (SLE) was suspected on the basis of positive antinuclear antibodies (ANA), moderately decreased total hemolytic complement, antibodies to histone, immunological abnormalities of kidney and skin biopsy. Symptoms of SLE involving other organs were absent.

Longitudinal Myelopathy in a Child with Systemic Lupus Erythematosus (SLE) – A rare case report and review of the literature

“…Discussion SLE-related myelopathy was first described in 1959 as a rare complication of systemic lupus erythematosus and is particularly rare in children with only 13 cases reported in patients younger than 18 years of age, mostly occurring in adolescents. [6][7][8][9][10] Published reports stated that lupus myelopathy had a stereotyped presentation in children. There were a variable time of onset of the systemic disease, acute flaccid paralysis, inflammatory cerebrospinal fluid profile with pleocytosis, positive antiphospholipid antibodies, extensive abnormality of spinal cord signal on MRI, and a variable prognosis for recovery.…”

“…There were a variable time of onset of the systemic disease, acute flaccid paralysis, inflammatory cerebrospinal fluid profile with pleocytosis, positive antiphospholipid antibodies, extensive abnormality of spinal cord signal on MRI, and a variable prognosis for recovery. [7][8][9][10] The differential diagnosis of transverse myelopathy in patients with SLE includes idiopathic transverse myelitis, viral infection, medullar compression due to vertebral fractures, epidural or subdural lipomatosis, epidural or paraspinal abscess complicating disc space infection, and atlantoaxial subluxation. 13 We considered that our patient's disease was systemic lupus erythematosus complicated with myelopathy.…”

“…5 It is particularly rare in children with only a few cases reported worldwide. [6][7][8][9][10] Transverse myelopathy is a process involving the gray and white matter in one or more adjacent spinal cord segments. Although rare, it has a dramatic and severe manifestation leading to rapidly involving motor and sensory deficits and sphincter dysfunction.…”