Concurrent longitudinally extensive transverse myelitis and spinal cord infarction in systemic lupus erythematosus: a case report

Case ReportLongitudinally extensive transverse myelitis (TM) is a serious neuropsychiatric manifestation of systemic lupus erythematosus (SLE), and spinal cord infarction is a rare but devastating condition with a poor prognosis.We report a case of a 37-year-old female with SLE who presented with fever, rash, and bilateral thigh pain and subsequently developed acute paraplegia with sensory loss below T10 and urinary retention.Magnetic resonance imaging (MRI) revealed extensive TM.Despite aggressive immunosuppressive therapy including high-dose corticosteroids, plasmapheresis, cyclophosphamide, and rituximab, her lower extremity weakness persisted.Follow-up MRI demonstrated improvement in cervical and upper thoracic cord inflammation; however, a new thoracolumbar cord infarction below T8 was observed, resulting in permanent paraplegia.The patient died of sepsis-related complications.This case demonstrates that an initial inflammatory presentation can mask a subsequent devastating ischemic event.This clinical lesson highlights the importance of careful reassessment for vascular complications using serial imaging, including diffusion-weighted imaging, especially in rapidly progressing myelopathy refractory to immunosuppression.