TRANSVERSE MYELITIS AS RESENTATION IN LUPUS PATIENT

 

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TRANSVERSE MYELITIS AS RESENTATION IN LUPUS PATIENT

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Nihal
Bashir
Nihal Bashir Nihalhamary@gmail.com Seha Kidney Care Nephrology AlAin United Arab Emirates *
Dana Kidder danakidder19@gmail.com Seha Kidney Care Nephrology AlAin United Arab Emirates -
Yousef Boobes yoboobes@seha.ae Seha Kidney Care Nephrology AlAin United Arab Emirates -
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Prevalence of ATM in the general population is estimated at 1–4 new cases per million per year, while in SLE it is seen in 1–2% of patients, 1000 times greater than the general population.

A 29-year-old female, previously healthy, presented with a 2-week history of bilateral eye puffiness and increased abdominal girth, followed by bilateral lower limb oedema and reduced urine output. She noted to have reduced movement in her lower limbs with foot drop and reduced reflexes bilaterally, power 2/5 in the right foot distally, 1/5 in the left foot. The patient had mouth ulcers, excessive hair fall but denied skin rashes, joint pain, chest pain, or abdominal pain. Laboratory investigations showed normal creatinine, urinary protein creatinine ratio 0.9 g/g with microscopic haematuria. Immunological workup showed positive Antinuclear antibodies, double-stranded DNA, and both complement C3 and C4 were low; lupus anticoagulants were negative. 

She had a CT with contrast for the chest, abdomen, and pelvis, which revealed a pulmonary embolism. She was started on therapeutic anticoagulation, for which a planned kidney biopsy was declined, and cyclophosphamide 500 mg iv with pulse steroids 1 g daily for 3 days, along with a desensitization dose of trimethoprim sulfamethoxazole and bone prophylaxis and hydroxychloroquine. An MRI of her spinal cord was suggestive of transverse myelitis. A multidisciplinary team discussion regarding the treatment concluded to start therapeutic plasma exchange for severe Systemic lupus erythematosus with transverse myelitis. She showed improvement following the second session and planned to complete 7 sessions. 

Improvement in neurological signs could be partially due to the effect of immunosuppression, which eased the spinal cord edema, not to plasma exchange alone in this case. Myelitis can also occur years following SLE diagnosis. 

Kewords