Seminars in Arthritis and Rheumatism
Volume 39, Issue 4 , Pages 246-256 , February 2010

Transverse Myelitis Affecting More Than 4 Spinal Segments Associated with Systemic Lupus Erythematosus: Clinical, Immunological, and Radiological Characteristics of 22 Patients

  • Gerard Espinosa, MD, PhD

      Affiliations

    • Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
    • Corresponding Author InformationAddress reprint requests to Gerard Espinosa, MD, PhD, Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalonia, Spain
    • ,
  • Andrea Mendizábal, MD

      Affiliations

    • Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
    • ,
  • Sonia Mínguez, MD

      Affiliations

    • Rheumatology Section, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
    • ,
  • Cristina Ramo-Tello, MD

      Affiliations

    • Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
    • ,
  • Jaume Capellades, MD, IDI

      Affiliations

    • Magnetic Resonance Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
    • ,
  • Alejandro Olivé, MD, PhD

      Affiliations

    • Rheumatology Section, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
    • ,
  • Ricard Cervera, MD, PhD

      Affiliations

    • Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain

References 

  1. Berman M, Feldman S, Alter M, Zilber N, Kahana E. Acute transverse myelitis: incidence and etiologic considerations. Neurology. 1981;31:966–971
  2. de Seze J, Stojkovic T, Breteau G, Lucas C, Michon-Pasturel U, Gauvrit JY, et al. Acute myelopathies: clinical, laboratory and outcome profiles in 79 cases. Brain. 2001;124:1509–1521
  3. Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59:499–505
  4. Provenzale JM, Barboriak DP, Gaensler EH, Robertson RL, Mercer B. Lupus-related myelitis: serial MR findings. Am J Neuroradiol. 1994;15:1911–1917
  5. Deodhar AA, Hochenedel T, Bennett RM. Longitudinal involvement of the spinal cord in a patient with lupus related transverse myelitis. J Rheumatol. 1999;26:446–449
  6. Kimura KY, Seino Y, Hirayama Y, Aramaki T, Yamaguchi H, Amano H, et al. Systemic lupus erythematosus related transverse myelitis presenting longitudinal involvement of the spinal cord. Intern Med (Tokyo, Japan). 2002;41:156–160
  7. Tellez-Zenteno JF, Remes-Troche JM, Negrete-Pulido RO, Davila-Maldonado L. Longitudinal myelitis associated with systemic lupus erythematosus: clinical features and magnetic resonance imaging of six cases. Lupus. 2001;10:851–856
  8. Yazawa S, Kawasaki S, Ohi T, Shiomi K, Sugimoto S, Kawagoe J, et al. Development of severe longitudinal atrophy of thoracic spinal cord following lupus-related myelitis. Intern Med (Tokyo, Japan). 2001;40:353–357
  9. Lehnhardt FG, Impekoven P, Rubbert A, Burghaus L, Neveling M, Heiss WD, et al. Recurrent longitudinal myelitis as primary manifestation of SLE. Neurology. 2004;63:1976
  10. Neumann-Andersen G, Lindgren S. Involvement of the entire spinal cord and medulla oblongata in acute catastrophic-onset transverse myelitis in SLE. Clin Rheumatol. 2000;19:156–160
  11. Chen HC, Lai JH, Juan CJ, Kuo SY, Chen CH, Chang DM. Longitudinal myelitis as an initial manifestation of systemic lupus erythematosus. Am J Med Sci. 2004;327:105–108
  12. Moranne O, Hachulla E, Valat AS, Sotoares G, Pagniez D, Boulanger E. Longitudinal myelitis in a pregnant patient with SLE. Am J Med. 2004;116:355–357
  13. Rheu CW, Lee SI, Yoo WH. A catastrophic-onset longitudinal myelitis accompanied by bilateral internuclear ophthalmoplegia in a patient with systemic lupus erythematosus. J Korean Med Sci. 2005;20:1085–1088
  14. Katramados AM, Rabah R, Adams MD, Huq AH, Mitsias PD. Longitudinal myelitis, aseptic meningitis, and conus medullaris infarction as presenting manifestations of pediatric systemic lupus erythematosus. Lupus. 2008;17:332–336
  15. Heinlein AC, Gertner E. Marked inflammation in catastrophic longitudinal myelitis associated with systemic lupus erythematosus. Lupus. 2007;16:823–826
  16. Kovacs B, Lafferty TL, Brent LH, DeHoratius RJ. Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature. Ann Rheum Dis. 2000;59:120–124
  17. Mok CC, Lau CS, Chan EY, Wong RW. Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome. J Rheumatol. 1998;25:467–473
  18. Lu X, Gu Y, Wang Y, Chen S, Ye S. Prognostic factors of lupus myelopathy. Lupus. 2008;17:323–328
  19. Touma Z, Atweh SF, Kibbi L, Arayssi T. Longitudinal myelitis in patient with systemic lupus erythematosus, homozygous prothrombin G20210A and heterozygous MTHFR 677T. Lupus. 2007;16:517–520
  20. Lehnhardt FG, Scheid C, Holtik U, Burghaus L, Neveling M, Impekoven P, et al. Autologous blood stem cell transplantation in refractory systemic lupus erythematosus with recurrent longitudinal myelitis and cerebral infarction. Lupus. 2006;15:240–243
  21. de Seze J, Lanctin C, Lebrun C, Malikova I, Papeix C, Wiertlewski S, et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology. 2005;65:1950–1953
  22. Sherer Y, Hassin S, Shoenfeld Y, Levy Y, Livneh A, Ohry A, et al. Transverse myelitis in patients with antiphospholipid antibodies—the importance of early diagnosis and treatment. Clin Rheumatol. 2002;21:207–210
  23. Ropper AH, Poskanzer DC. The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms. Ann Neurol. 1978;4:51–59
  24. Harisdangkul V, Doorenbos D, Subramony SH. Lupus transverse myelopathy: better outcome with early recognition and aggressive high-dose intravenous corticosteroid pulse treatment. J Neurol. 1995;242:326–331
  25. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46:1019–1027
  26. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients (The European Working Party on Systemic Lupus Erythematosus). Medicine (Baltimore). 1993;72:113–124
  27. Lavalle C, Pizarro S, Drenkard C, Sanchez-Guerrero J, Alarcon-Segovia D. Transverse myelitis: a manifestation of systemic lupus erythematosus strongly associated with antiphospholipid antibodies. J Rheumatol. 1990;17:34–37
  28. Markusse HM, Haan J, Tan WD, Breedveld FC. Anterior spinal artery syndrome in systemic lupus erythematosus. Br J Rheumatol. 1989;28:344–346
  29. D'Cruz DP, Mellor-Pita S, Joven B, Sanna G, Allanson J, Taylor J, et al. Transverse myelitis as the first manifestation of systemic lupus erythematosus or lupus-like disease: good functional outcome and relevance of antiphospholipid antibodies. J Rheumatol. 2004;31:280–285
  30. Barile-Fabris L, Ariza-Andraca R, Olguin-Ortega L, Jara LJ, Fraga-Mouret A, Miranda-Limon JM, et al. Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus. Ann Rheum Dis. 2005;64:620–625
  31. Trevisani VF, Castro AA, Neves Neto JF, Atallah AN. Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database of Systematic Reviews. 2006;Issue 2. Art. No.: CD002265. DOI:10.1002/14651858.CD002265.pub2.
  32. Pagnoux C. Plasma exchange for systemic lupus erythematosus. Transfus Apher Sci. 2007;36:187–193
  33. Neuwelt CM. The role of plasmapheresis in the treatment of severe central nervous system neuropsychiatric systemic lupus erythematosus. Ther Apher Dial. 2003;7:173–182
  34. Szczepiorkowski ZM, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2007;22:106–175
  35. Bhat P, Radhakrishnan J. B lymphocytes and lupus nephritis: new insights into pathogenesis and targeted therapies. Kidney Int. 2008;73:261–268
  36. Armstrong DJ, McCarron MT, Wright GD. SLE-associated transverse myelitis successfully treated with Rituximab (anti-CD20 monoclonal antibody). Rheumatol Int. 2006;26:771–772

 The authors have no conflicts of interest to disclose.

PII: S0049-0172(08)00188-1

doi: 10.1016/j.semarthrit.2008.09.002

Seminars in Arthritis and Rheumatism
Volume 39, Issue 4 , Pages 246-256 , February 2010

Article Tools

* Image Usage & Resolution