Shadravan Mohammad Mehdi, Farshchian Farnoosh, Rajaei Alireza, Alavi Darazam Ilad, Naseri Reza, Maghsudloo Faezeh
Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
IDCases. 2025 Jul 29;41:e02336. doi: 10.1016/j.idcr.2025.e02336. eCollection 2025.
Acute transverse myelitis (ATM) is a rare inflammatory disorder that affects the spinal cord, leading to sudden weakness, sensory deficits, and bowel/bladder dysfunction. Also rare, this condition can be caused by infections such as the Varicella-zoster virus (VZV) or can occur as a complication of systemic lupus erythematosus (SLE). It has been reported to be more prevalent in SLE patients compared to VZV infections. We present a case of a patient with a history of SLE and evidence of vesicular rash from VZV infection.
A 61-year-old female presented with progressive weakness in her lower limbs. Two weeks before, she had developed a vesicular rash due to a VZV infection in the T6-T9 dermatomes, which was followed by paraparesis, sensory loss, and urinary retention. She also had a history of SLE. During the physical examination, muscle strength and sensation were decreased in the lower limbs. MRI revealed central myelopathy from T6 to T10. In laboratory tests, VZV PCR was positive, and Aquaporin-4 was also negative. The patient was treated with IV corticosteroid pulse and ganciclovir, followed by plasma exchange. resulted in partial recovery.
This case highlights VZV-induced TM (VZV-TM) in an immunocompromised patient with underlying SLE. Despite overlapping etiologies, a thorough clinical, radiologic, and laboratory evaluation, including a positive CSF VZV PCR and the absence of a SLE flare, supported VZV-TM as the final diagnosis. Prompt antiviral therapy and escalation to plasma exchange led to substantial neurological recovery.
急性横贯性脊髓炎（ATM）是一种罕见的炎症性疾病，会影响脊髓，导致突然出现的肌无力、感觉障碍以及肠道/膀胱功能障碍。同样罕见的是，这种病症可能由水痘-带状疱疹病毒（VZV）等感染引起，或者作为系统性红斑狼疮（SLE）的并发症出现。据报道，与VZV感染相比，SLE患者中这种病症更为普遍。我们报告一例有SLE病史且有VZV感染所致水疱疹证据的患者。
一名61岁女性出现下肢进行性肌无力。两周前，她因T6 - T9皮节的VZV感染出现水疱疹，随后出现双下肢轻瘫、感觉丧失和尿潴留。她也有SLE病史。体格检查时，下肢肌力和感觉减退。MRI显示T6至T10节段的脊髓病。实验室检查中，VZV PCR呈阳性，水通道蛋白4也为阴性。患者接受了静脉注射皮质类固醇冲击治疗和更昔洛韦治疗，随后进行了血浆置换。治疗后部分恢复。
本病例突出了在患有潜在SLE的免疫功能低下患者中VZV诱导的横贯性脊髓炎（VZV - TM）。尽管病因有重叠，但全面的临床、影像学和实验室评估，包括脑脊液VZV PCR阳性且无SLE病情加重，支持VZV - TM作为最终诊断。及时的抗病毒治疗并升级为血浆置换导致了显著的神经功能恢复。
