TRANSVERSE MYELITIS COMPLICATING SYSTEMIC LUPUS-ERYTHEMATOSUS - TREATMENT INCLUDING HYDROXYCHLOROQUINE - CASE-REPORT

Transverse myelitis has been cited as a rare and unusual complication of systemic lupus erythematosus (SLE). A review of the literature reve als only 10 cases of transverse myelitis as the initial presentation o f SLE, and only one with reported benefits from antimalarial therapy. The case of a 30-year-old woman is reviewed. She presented to the emer gency room with complaints of hypogastric and low back pain. The ensui ng course was one of frank urinary retention and rapidly progressing q uadriparesis. Magnetic resonance imaging of the spine revealed marked edema of the cervical and thoracic spine. A diagnosis of SLE was based on positive antinuclear antibodies and leukopenia. The patient was tr eated with high dose methylprednisolone, plasmapheresis and pulse cycl ophosphamide for 3 months. Subsequently, treatment was begun with hydr oxychloroquine, and significant improvement in her neurologic and func tional status was achieved after 1 month of therapy. Ten months after her onset of symptoms, the patient suffered an acute exacerbation of p araparesis and urinary retention. Again, she improved clinically after high dose methylprednisolone and pulse cyclophosphamide for 1 month. Hydroxychloroquine was continued throughout the duration of therapy.