Systemic lupus erythematosus (SLE)-associated myelitis is an uncommon but potentially disabling neurological manifestation that can present with radiological features resembling other intramedullary spinal cord disorders. Imaging findings may overlap with demyelinating diseases or intramedullary tumors such as spinal glioblastoma, which can lead to diagnostic uncertainty and consideration of invasive procedures. Early recognition is important because prompt initiation of glucocorticoid (GC) and immunosuppressive therapy may result in neurological improvement. A 48-year-old woman with a long-standing history of SLE presented with progressive numbness and mild weakness of the lower extremities. Spinal MRI demonstrated an intramedullary lesion at the Th1-2 level with T2 hyperintensity and heterogeneous gadolinium enhancement, initially raising suspicion for spinal glioblastoma. Cerebrospinal fluid analysis revealed mild pleocytosis without oligoclonal bands, and both aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative. Given the possibility of inflammatory myelitis, GC therapy was initiated. Her sensory symptoms improved within several days, and a follow-up MRI performed one week later showed a marked reduction in lesion size and contrast enhancement. Surgical intervention was therefore deferred. The patient has remained relapse-free for 20 months under a gradual GC taper. This case demonstrates that SLE-associated myelitis can closely mimic spinal glioblastoma on MRI. Responsiveness to GC therapy and short-interval follow-up imaging can provide important diagnostic clues and help avoid unnecessary surgical procedures. Autoimmune myelitis should be considered in the differential diagnosis of intramedullary spinal cord lesions.
Sakaeyama et al. (Sun,) studied this question.