Extensive Longitudinal Transverse Myelitis in Systemic Lupus Erythematosus: Case Report and Review of Current Literature

Acute transverse myelitis (TM) is an inflammatory condition that presents with quickly advancing motor, sensory, and autonomic symptoms, which can have severe consequences. The three leading causes of acute TM are demyelinating diseases, infections, and autoimmune inflammatory conditions like systemic lupus erythematosus (SLE). The American College of Rheumatology (ACR) includes TM as one of the 19 neuropsychiatric conditions linked with SLE, with an incidence rate of about 1–2% among SLE cases. Misdiagnosis is common, often resulting in high morbidity and mortality. This report examines the case of a 23-year-old woman with progressive muscle weakness in her lower limbs, dysesthesias from the abdomen to the feet, and loss of sphincter control. On examination, severe paraparesis with sensory level at T8 was identified. MRI of the thoracolumbar spine showed hyperintensity on T2 and STIR sequences from T7 to L1, consistent with TM. Due to resistance to initial treatment, cyclophosphamide was administered. After a week in the hospital, the patient showed partial neurological improvement. Recognizing TM in SLE patients requires high clinical suspicion, and early intervention is crucial to minimize severe complications and reduce the rates of morbidity and mortality.