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Lupus
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case-report

Longitudinal myelitis, aseptic meningitis, and conus medullaris infarction as presenting manifestations of pediatric sysemic lupus erythematosus

AM Katramados

Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA

R Rabah

Department of Pathology, Children’s Hospital of Michigan, Detroit, Michigan, USA

MD Adams

Department of Pediatric Rheumatology, Children’s Hospital of Michigan, Detroit, Michigan, USA

AHMM Huq

Department of Pediatrics and Neurology, Children’s Hospital of Michigan, Detroit, Michigan, USA

PD Mitsias

Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA

A healthy boy developed subacutely progressive quadriparesis, complicated by sudden paraplegia, fever, and meningeal signs, diagnosed as longitudinal myelitis, aseptic meningitis, and conus medullaris infarction and identified as the presenting manifestations of neuropsychiatric systemic lupus erythematosus. Rapid expansion of the conus on serial neuroimaging led to emergent decompressive laminectomy and cord biopsy showing vasculitis and cord infarction. The patient had partial recovery after treatment with high-dose steroids. Increased vigilance is required when pediatric patients develop a similar subacute presentation on the ground of active systemic lupus erythematosus because it may herald the onset of a catastrophic neurological syndrome.

Key Words: antiphospholipid syndrome • neuropsychiatric lupus • systemic lupus erythematosus • thrombosis • vasculitis

Lupus, Vol. 17, No. 4, 332-336 (2008)
DOI: 10.1177/0961203307086638
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