Transverse Myelitis in Lupus

Systemic lupus erythematosus (SLE) may be associated with neurologic manifestations including headache, seizures, aseptic meningitis, and psychosis. Myelopathy occurs in 1–1.5% of SLE patients. The most common pattern is acute transverse myelitis (ATM), primarily in the form of longitudinally extensive transverse myelitis (LETM). ATM tends to occur within the first 5 years from diagnosis, and in nearly half the cases, it is the first clinical manifestation of SLE. A recurrence of myelitis is seen within several months of the first event, and at least one recurrence occurs in 21–55% of patients. Due to the low incidence of SLE-associated ATM, little information on treatment efficacy is available, although immunotherapies such as steroids, cyclophosphamide, and rituximab have been tried.