[Acute transverse myelitis in seven patients with systemic lupus erythematosus]. / Mielitis transversa aguda en siete pacientes con lupus eritematoso sistémico.

INTRODUCTION: Although the association between transverse myelitis and systemic lupus erythematosus is rather infrequent, it is important to take this form of clinical presentation into account because it is a serious complication, which can potentially be treated but even when dealt with in the early stages does not always have a good prognosis. PATIENTS AND METHODS: We conducted a retrospective review over the past 13 years of the cases that have been admitted to our specific centre for the treatment of spinal cord injuries that were diagnosed as suffering from myelitis associated with disseminated lupus erythematosus. Demographic and clinical data, together with data about acute phase and maintenance treatments, as well as the patients' progress and sequelae are described. RESULTS: The case reports of seven patients, all of whom were young females, are studied. In two cases, myelitis was the initial presentation of lupus. The main disorder was at the dorsal, followed by the cervical, levels. Only two patients had a favourable long-term progression from the neurological point of view (both managed to walk) despite acute treatment with high doses of intravenous corticoids, and regardless of the fact that cyclophosphamide was later used. CONCLUSIONS: Myelitis associated to lupus is a rare manifestation but, owing to its important functional repercussions, it must be taken into account when faced with an acute clinical picture involving the spinal cord; this is particularly the case when it occurs in young females, with or without a previous diagnosis of autoimmune disease.

Mielitis transversa aguda en siete pacientes con lupus eritematoso sistémico / Acute transverse myelitis is seven patients with systemic lupus erythematosus

Introducción. Aunque la asociación entre mielitis transversa y lupus eritematoso sistémico es bastante infrecuente, es importante tener en cuenta esta forma de presentación clínica, porque se trata de una complicación grave, con tratamiento potencial, que incluso con intervención temprana no siempre se asocia a un buen pronóstico. Pacientes y métodos. Revisamos de forma retrospectiva durante los últimos 13 años los casos que han ingresado en nuestro centro específico para el tratamientode lesión medular, con diagnóstico de un cuadro de mielitis asociada a lupus eritematoso diseminado. Se describen los datos demográficos, clínicos, el tratamiento realizado en la fase aguda y de mantenimiento, así como su evolución y secuelas.Resultados. Se estudian los casos clínicos de siete pacientes, todas ellas mujeres jóvenes. En dos de ellas la mielitis fue la forma de inicio del lupus. La afectación predominante fue a nivel dorsal y después cervical. Sólo dos pacientes tuvieron una evolución favorable a largo plazo desde el punto de vista neurológico, consiguiendo la deambulación, a pesar del tratamiento agudo con corticoides intravenosos en dosis altas, con independencia de que posteriormente se utilizase ciclofosfamida.Conclusión. La mielitis asociada al lupus es una manifestación infrecuente, pero debe tenerse en cuenta ante un cuadro medular agudo, sobre todo si éste ocurre en mujeres jóvenes, con o sin el diagnóstico previo de la enfermedad autoinmune, debido a su importante repercusión funcional

Introduction. Although the association between transverse myelitis and systemic lupus erythematosus is rather infrequent, it is important to take this form of clinical presentation into account because it is a serious complication, which can potentially be treated but even when dealt with in the early stages does not always have a good prognosis. Patients and methods. We conducted a retrospective review over the past 13 years of the cases that have been admitted to our specific centre for the treatment of spinal cord injuries that were diagnosed as suffering from myelitis associated with disseminated lupuserythematosus. Demographic and clinical data, together with data about acute phase and maintenance treatments, as well as the patients’progress and sequelae are described. Results. The case reports of seven patients, all of whom were young females, are studied. In two cases, myelitis was the initial presentation of lupus. The main disorder was at the dorsal, followed by the cervical, levels. Only two patients had a favourable long-term progression from the neurological point of view (both managedto walk) despite acute treatment with high doses of intravenous corticoids, and regardless of the fact that cyclophosphamide was later used. Conclusions. Myelitis associated to lupus is a rare manifestation but, owing to its important functional repercussions, it must be taken into account when faced with an acute clinical picture involving the spinal cord; this is particularly the case when it occurs in young females, with or without a previous diagnosis of autoimmune disease