When Lupus Strikes: Acute Longitudinal Extensive Transverse Myelitis as Unusual Presentation of Systemic Lupus Erythematosus

Acute transverse myelitis (ATM) is a rare manifestation of systemic lupus erythematosus (SLE), with an estimated prevalence of 0.9% to 1.1%. It tends to progress rapidly and generally presents with sensory, motor, and autonomic defects. Acute transverse myelitis can be idiopathic or secondary to numerous diseases, such as systemic autoimmune diseases, mainly SLE, which should always be included in the differential diagnoses, especially in young females. Diagnostic workup mainly includes magnetic resonance imaging (MRI) of the spine and cerebrospinal fluid (CSF) analysis. Magnetic resonance imaging typically shows a hyperintense lesion on T2-weighted MRI, and CSF analysis reveals pleocytosis. The prognosis is variable and is affected by multiple factors, including the initial disease severity and the time to initiation of therapy. If untreated, ATM can lead to serious complications and permanent neurological deficits. Pulse steroid therapy and cyclophosphamide constitute the mainstay of therapy for ATM. This report describes a case of a 29-year-old female patient who presented with bilateral lower extremity numbness and progressive weakness, with subsequent urinary retention. Imaging and laboratory investigations led to the diagnosis of SLE-associated ATM. Treatment was initiated promptly and yielded a good response and neurological recovery.