Myelitis in systemic lupus erythematosus

Abstract

LETTERS C2 and C3. In 1982, he developed essential hypertension, for which he was treated with a diuretic. He made no mention of joint complaints. During 1984 he developed a progressively spastic walk, pathologic reflexes, and reduced pain and vibration sensation.Further investigations showed a tumerous process at the occipitocervical level that had compressed the cervical cord. Because of suspicion of malignancy, an operation was performed, and a cheesy, chalky, intradural mass was partially removed. Bacteriologic investigation excluded tuberculosis. Despite alcohol fixation, light and polarizing microscopic investigations revealed several needle-shaped, negative birefringence crystals which were characteristic of monosozdium urate crystals. The cerebrospinal fluid was not available for polarization microscopy. Again, there was no history of joint complaints. Examination, however, showed severe arthritis of the first metatarsophalangeal joint on the left hand. There were no tophi or signs of arthritis in other joints. Microscopic examination of the synovial fluid, obtained by puncture of the affected joint, also revealed urate crystals. Serum urate concentration was 0.50 mmolesiliter. Urinary excretion of urate measured 1.22 mmoles/24 hours. Serum creatinine concentration was 132 pmolesiliter.Accordingly, a diagnosis of tophaceous gout of the cervical spine, without peripheral tophi, was made. The tophus had been almost completely removed, and the neurologic symptoms disappeared after the operation. A followup computed tomography scan and cervical myelogram were not performed. The patient's arthritis symptoms subsided with colchicine therapy. The urate concentration returned to normal level after additional allopurinol therapy, but it was necessary to continue the diuretics.