Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China.
Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China..
Autoimmun Rev. 2022 Jun;21(6):103103. doi: 10.1016/j.autrev.2022.103103. Epub 2022 Apr 20.
Acute transverse myelitis (TM) is a rare complication secondary to systemic lupus erythematosus (SLE) that can cause patients' extensive and severe neuropsychiatric disorders. Due to the rarity of the onset of acute TM, there is still no standard treatment protocol. This study was to summarize the clinical features of SLE-TM through a case report and systematic review.
We report a case of acute TM with the initial symptoms of headache and fever on admission to hospital, with lesions in medulla oblongata, cervical medulla, and thoracic medulla. Furthermore, all cases of SLE combined with acute TM from January 1975 to February 2022 were concluded and reviewed to compare the disease's current treatment strategies and prognosis.
Patients with SLE-TM are mainly female (97.65%), with an average age of 36.89, a TM incidence of 24.51% and a longitudinal myelitis (LM) incidence of 67.76%. In addition, 68.63% of patients present an increased albumin, and only 16.50% of patients could recover. 32.35% of patients showed positive anti-cardiolipin antibody. Moreover, the patients who could recover are generally younger than those in the improved and paraparesis groups. After classifying the statistical results twice according to magnetic resonance imaging results and prognosis respectively, the erythrocyte sedimentation rate (ESR) in LM group was significantly higher than that in the other two groups. The positive rate of anti-DNA and anti-cardiolipin antibody (ANCL) in TM group was significantly higher than that of the other groups. According to the prognostic grouping, ESR in the recovery group was significantly higher than those in the other two groups. The positive ANCL in the poor prognosis group was slightly higher than that in the other two groups.
We offer a novel insight for this rare disease and hope to bring some inspiration the basic research for SLE-TM.
急性横贯性脊髓炎（TM）是系统性红斑狼疮（SLE）的罕见并发症，可导致患者广泛而严重的神经精神障碍。由于急性 TM 的发病罕见，目前仍没有标准的治疗方案。本研究通过病例报告和系统回顾总结了 SLE-TM 的临床特征。
我们报告了一例急性 TM 病例，入院时的初始症状为头痛和发热，病变位于延髓、颈髓和胸髓。此外，对 1975 年 1 月至 2022 年 2 月期间所有 SLE 合并急性 TM 的病例进行了总结和回顾，以比较该病目前的治疗策略和预后。
SLE-TM 患者主要为女性（97.65%），平均年龄 36.89 岁，TM 发生率为 24.51%，纵向脊髓炎（LM）发生率为 67.76%。此外，68.63%的患者白蛋白升高，只有 16.50%的患者可以恢复。32.35%的患者抗心磷脂抗体阳性。此外，能够恢复的患者通常比改善和截瘫组的患者年轻。根据磁共振成像结果和预后将统计结果分别分类两次后，LM 组的红细胞沉降率（ESR）明显高于其他两组。TM 组的抗 DNA 和抗心磷脂抗体（ANCL）阳性率明显高于其他两组。根据预后分组，恢复组的 ESR 明显高于其他两组。预后不良组的阳性 ANCL 略高于其他两组。
我们为这种罕见疾病提供了新的见解，并希望为 SLE-TM 的基础研究带来一些启示。
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