Longitudinal Transverse Myelitis in a Case of Systemic Lupus Erythematosus: A Clinical Analysis and Review of the Literature

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a relapsing-remitting course and multisystem involvement, including the central nervous system (CNS). Neuropsychiatric manifestations in SLE vary widely and may include psychiatric disorders, seizures, cerebrovascular diseases, neuropathy, and cognitive dysfunction. Among the rare but severe complications is transverse myelitis (TM), an inflammatory disorder of the spinal cord that can cause motor, sensory, and autonomic dysfunction. In SLE, TM has an estimated incidence of 0.5% to 1%, with TM as the initial presentation in 30-60% of cases. The pathogenic mechanisms of SLE-related TM are complex, involving autoimmune responses with autoantibodies such as anti-dsDNA and antiphospholipid antibodies, which contribute to vascular damage and inflammation. A 59-year-old female with a history of SLE presented to the emergency department with lower limb sensory alterations, sudden loss of gait, and dysautonomia. Neurological examination revealed motor strength 0/5 in the lower limbs, areflexia, and hypotonia, with sensory level at T10. MRI findings indicated ischemic spinal infarction from T4 to T12, suggestive of longitudinally extensive TM. Given the absence of compressive pathology and infectious causes, high-dose corticosteroids and plasma exchange were initiated based on European League Against Rheumatism (EULAR) guidelines.