Discussion
The most prevalent SLE neurological symptoms are seizures, psychosis, or
headache. 1-2 percent of SLE patients’ Acute Transverse Myelitis (ATM)
is seen, while in one adult study, up to 39 percent of subjects are
presenting features (4, 10, 11). S. Zhang et al. (12) demonstrated that
patients over the age of 40 years were more likely to have developed
severe myelitis initially, explaining why younger individuals have a
poor prognosis. Moreover, extensive spinal cord lesions, initial severe
neurological impairment, delayed steroid impulse therapy, and
hyper-inflammation could predict a poor prognosis of systemic lupus
erythematosus with Transverse Myelitis. Meanwhile, another study shows
that Transverse myelitis may present as a symptom of SLE or develop more
than ten years after diagnosis of SLE. The primary prognostic factor is
the severity of the initial neurological flare (with paraplegia). Thus,
ATM signs and unexplained sensory complaints should elicit additional
examinations in patients with SLE (13).
The majority of cases who develop ATM complications do so within five
years after being diagnosed with SLE. The classical presentation of ATM
may occur in SLE patients, such as sphincter disturbances, motor
weakness, and sensory disturbance. Our patient did not show typical SLE
or transverse myelitis symptoms. Our patient was diagnosed with SLE
according to the presence of positive immunological markers and an
atypical clinical presentation of longitudinal myelitis. Although the
mechanism by which ATM causes SLE is unknown, it is most likely caused
by immune complex-mediated thrombosis or vasculitis, which results in
ischemic spinal lesions, or by anti-phospholipid antibodies
cross-reacting with spinal cord phospholipids (11, 14). In SLE patients
where ATM is presenting manifestation, numerous patients probably do not
fulfill SLE diagnostic criteria; however, during the disease, they may
develop further signs and symptoms of SLE in the future (4). Although
the ANA and double-stranded DNA antibodies were positive in our reported
case, the patient showed no additional clinical symptoms associated with
SLE. The patient, after aggressive therapy, showed reasonable
improvement.
Steroids in Intravenous pulse methylprednisolone and immunosuppressant
such as cyclophosphamide are used in the general therapy strategy (10,
15). This combination of therapies appears to have a more favorable
outcome. However, the prognosis is often seen as bad in patients with
SLE. Plasmapheresis has been utilized in some patients, although its
role is unclear (14). Although most SLE-associated ATM patients have
satisfactory neurologic outcomes following high-dose corticosteroid
therapy, some patients have a recurrence and permanent neurologic
deficits (16).
In conclusion, this study shows that ATMs may, on rare occasions,
represent the initial manifestation of SLE. ATM secondary to SLE,
despite improved treatment methods, can have a bad prognosis and
requires more than only steroids. Early detection and aggressive
treatment can help prevent long-term irreparable damage and may
positively result. This article underlines the importance of multicenter
studies and establishing a registry for individuals with SLE who have
ATMs to aid in the study of best management choices.
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