Myelopathy as a first manifestation of systemic lupus erythematosus: two cases and literature review

Introduction.-Myelopathy is a rare manifestation of systemic lupus erythema tosus, occurring most often during the course of the disease. Exegesis.-We report two cases of women with myelopathy as the first manifes tation of systemic lupus erythematosus; both had an unusual course. We revi ew the literature for previously reported cases. Conclusion.-The clinical presentation of myelitis is heterogeneous. Usually , neurologic deficits evolve within a few hours (typically acute transverse myelitis) and outcome is usually poor. However, chronic or recurrent trans verse myelitis has also been reported, including relapsing myelitis that re solved spontaneously. Myelopathy can be the first manifestation of the dise ase and this might be more common than initially thought. Magnetic resonanc e imaging (MRI) findings depend on the timing of the examination and the st age of the disease; the MRI may therefore be normal. An association with op tic neuritis is frequently reported in the literature and differential diag nosis with multiple sclerosis may be difficult. Overlapping features betwee n both diseases have been termed "lupoid sclerosis" and are actually classi fied as demyelinating syndromes associated with lupus. Myelopathy does not appear to be consistently associated with antiphospholipid antibodies, as h as been previously suggested The best treatment protocol has not been deter mined; however, in recent years, pulses of methylprednisolone and cyclophos phamide have gained acceptance by most authors. (C) 2000 Editions scientifi ques et medicales Elsevier SAS.