engleski

Transverse myelitis as initial symptom in a patient with connective tissue disease: a case report

Transverse myelitis (TM) is a monofocal inflammatory disorder of the spinal cord in which an immune-mediated process results in neural injury. It may exist as an idiopathic entity, as a part of a multifocal diseases of the central nervous sistem, or a multisystemic connective tissue disease. Transverse myelitis as a manifestation of an autoimmune disorder occurs in approximately 1% of patients, and as initial symptom it is described only in a case reports. A 49-year-old woman was admitted to the Department of Neurology of the University Hospital Center Zagreb in September 2006, due to sudden development of weakness in legs, accompanied with Th11 sensory level and urinary retention. Magnetic resonance imaging (MRI) of the caudal part of the spinal cord revealed two spacky T2 hyperintensive demyelinating lesions which comprise less then 50% of the surface, in the lateral parts of thoracal spinal cord, in the Th10 segment on the left and Th11 on the right. Cerebrospinal fluid (CSF) analysis showed little increase of total protein (45 mg/dl), oligoclonal bands were negative, and there were 4 lymphocytes mm-3. She had positive antinuclear antibody (ANA) titer. Patient was treated with pulse glucocorticoid therapy during 7 days, followed by peroral glucocorticoid therapy (taper) with improvement of her symptoms. In the following few monts patient developed clinical signs and symptoms (episodes of polyarthritis, febrile episodes, and skin photosensitivity), that, together with positive ANA titer, led the clinical immunologist to the diagnosis of probable systemic lupus erythematosus (SLE). Patient showed good clinical response to chronic oral immunosuppresive therapy (methotrexate). On control MRI performed in November 2008 formerly described demyelinating lesions disappeared. This case report is one of rare cases with acute spinal symptomatology as an initial manifestation of the connective tissue disease in our Department. Our experience suggest the glucocorticoid therapy and diagnostic procedures recommended by the Algorithm for the diagnosis and treatment of transverse myelitis.

transverse myelitis; connective tissue disease; glucocorticoid therapy

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