Unseen Struggles: Understanding Relapsing Transverse Myelitis in Children and Its Impact on Their Future

Objective: To educate medical professionals on recognizing symptoms and signs of relapsing myelitis and the management of relapsing myelitis. Case Presentation: A 17-year-old woman presented with sudden-onset lower extremity weakness, sensory changes, urinary retention, and constipation. Physical examination revealed hyperreflexia, weakness in both lower limbs, and sensory loss. MRI of the spine showed a pathological intramedullary spinal intensity area extending throughout the spinal cord from the C2 segment down to T11, suggestive of Multiple Sclerosis or Syringomyelia. The patient also has a history of Sjogren's syndrome. Laboratory investigations were negative for known infectious agents. The patient was initially treated with high-dose corticosteroids, leading to partial recovery. As a result, IVIG was administered. After the acute phase was resolved, the patient was placed on long-term therapy with azathioprine and methylprednisolone. Four months later, the patient experienced similar complaints. In this relapse, high-dose corticosteroids were administered, and the acute phase was resolved. Three months later, the patient experienced a recurrence of symptoms, presenting with similar patterns of rapid-onset weakness, sensory changes, urinary retention, and constipation. MRI again showed a lesion in the central spinal medulla extending from the C2 to Th11 level. After receiving IVIG again, the patient's long-term therapy was changed to mycophenolate mofetil and methylprednisolone. Conclusion: Although recurrent transverse myelitis in children is rare, it is important to recognize and treat it promptly. A thorough clinical assessment, including an MRI, is essential for identifying the underlying cause and guiding appropriate treatment. Early treatment can enhance recovery and minimize the likelihood of future episodes.