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

This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document. Acute transverse myelitis (ATM) is a rare inflammatory disorder characterized by rapidly evolving motor, sensory, and autonomic dysfunction, which can lead to severe outcomes. The main etiologies include demyelinating diseases, infections, and autoimmune conditions such as systemic lupus erythematosus (SLE). The American College of Rheumatology (ACR) recognizes ATM as one of the 19 neuropsychiatric manifestations of SLE, with an estimated incidence of 1% - 2% among SLE patients. Misdiagnosis is frequent and often associated with significant morbidity and mortality. We report the case of a 23-year-old woman presenting with progressive weakness of the lower limbs, dysesthesias extending from the abdomen to the feet, and sphincter dysfunction. Clinical examination revealed severe paraparesis with a sensory level at T8. MRI of the thoracolumbar spine demonstrated extensive T2 and STIR hyperintensity from T7 to L1, consistent with ATM. Due to inadequate response to initial therapy, cyclophosphamide was administered. After one week of hospitalization, the patient showed partial neurological improvement. Early recognition of transverse myelitis in the context of SLE requires a high index of suspicion. Prompt intervention is essential to prevent severe complications and to reduce morbidity and mortality rates.