Abstract: Transverse Myelitis as the First Manifestation of Systemic Lupus Erythematosus or Lupus-like Disease: Good Functional Outcome and Relevance of Antiphospholipid Antibodies

Transverse Myelitis as the First Manifestation of Systemic Lupus Erythematosus or Lupus-like Disease: Good Functional Outcome and Relevance of Antiphospholipid Antibodies

DAVID P. D'CRUZ, SUSANA MELLOR-PITA, BEATRIZ JOVEN, GIOVANNI SANNA, JUDITH ALLANSON, JAMES TAYLOR, MUNTHER A. KHAMASHTA, and GRAHAM R.V. HUGHES

ABSTRACT.

Objective. Transverse myelitis (TM) is a rare complication of systemic lupus erythematosus (SLE). Although usually a late manifestation of SLE, it can occur at presentation. We investigated the clinical presentation, treatment and outcome of 15 patients with TM as the presenting manifestation of SLE or lupus-like disease.

Methods. All patients received corticosteroids, while 13 also received immunosuppressive therapy. Five patients were fully anticoagulated with warfarin.

Results. A sensory level with spastic lower limb weakness and sphincter disturbance was the most common presentation: 14/15 patients had a thoracic or cervical sensory level. Cerebrospinal fluid examination showed high protein concentrations in 3 patients and oligoclonal bands in 8. Eleven of the 15 (73%) had antiphospholipid antibodies (aPL). Of the 15 patients, 3 had complete resolution of the symptoms, 6 had good functional improvements, 5 had good to fair outcome with some functional deficit, and one patient who received corticosteroids alone later died from pneumonia.

Conclusion. We describe 15 patients with TM as the presenting manifestation of SLE or lupus-like disease with a high prevalence of aPL. Our data support the view that early diagnosis and immunosuppressive therapy may be superior to corticosteroids alone in improving functional outcome. In those patients with aPL, antiplatelet agents and/or warfarin should also be considered. (J Rheumatol 2004;31:280-5)

Key Indexing Terms:

TRANSVERSE MYELITIS
SYSTEMIC LUPUS ERYTHEMATOSUS
LUPUS-LIKE DISEASE
ANTIPHOSPHOLIPID ANTIBODIES
CYCLOPHOSPHAMIDE

From The Louise Coote Lupus Unit, St. Thomas' Hospital, London; Rivermead Rehabilitation Centre, Oxford; and Northampton General Hospital, Northampton, United Kingdom.

D.P. D'Cruz, MD, FRCP; S. Mellor-Pita, MD, PhD; B. Joven, MD, PhD; G. Sanna, MD, PhD; M.A. Khamashta, MD, PhD, FRCP; G.R.V. Hughes, MD, FRCP, Louise Coote Lupus Unit, St. Thomas' Hospital; J. Allanson, PhD, MRCP, Rivermead Rehabilitation Centre; J. Taylor, MRCP, Northampton General Hospital.

Address reprint requests to Dr. D.P. D'Cruz, The Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, London SE1 7EH, UK. E-mail: david.d'cruz@kcl.ac.uk

Submitted July 23, 2002; revision accepted April 15, 2003.