JRD Journal of Rheumatic Diseases J Rheum Dis 2093-940X 2233-4718 The Korean College of Rheumatology 10.4078/jrd.2013.20.1.64 jrd-20-64 Case Report A Case of Systemic Lupus Erythematosus with Myelitis and Recurrent Neuromyelitis Optica LeeJa Young KimYou Jeong LeeJi Hyun Division of Rheumatology, Department of Internal Medicine, Maryknoll Hospital, Busan, Korea Corresponding to : Ji Hyun Lee, Division of Rheumatology, Department of Internal Medicine, Maryknoll Hospital, Daecheong-dong 4-ga, Jung-gu, Busan 600-730, Korea. E-mail : ete@lycos.co.kr 2 2013 31 2 2013 20 1 64 67 29032012 17042012 17042012 Copyright © 2013 The Korean College of Rheumatology 2013 This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Neuromyelitis optica (NMO) is an idiopathic, severe inflammatory demyelinating disease of the central nervous system targeting optic nerves and the spinal cord. It is characterized by acute bilateral visual loss (optic neuritis), acute transverse myelitis, and tends to spare brain early in the disease course. NMO can occur as an isolated con-dition or secondary to infection, toxin exposure, and autoimmune disease including systemic lupus erythematosus (SLE), sarcoidosis, and Behcet's disease. We experienced a case of SLE with myelitis and recurrent optic neuritis in a 28-year-old woman who presented with recurrent visual disturbance and sudden onset of paraplegia, and report here on this case along with a review of the relevant literature.

 Systemic lupus erythematosus Neuromyelitis optica References Wingerchuk DM Hogancamp WF O'Brien PC Weinshenker BG The clinical course of neuromyelitis optica (Devic's syndrome) Neurology 1999 53 110714 Mandler RN Neuromyelitis optica - Devic's syndrome, update Autoimmun Rev 2006 5 53743 Ahn TB Yoon BW A case of systemic lupus erythematosus with recurrent myelitis and optic neuritis J Korean Neurol Assoc 2000 18 65760 Oh PC Kim GH Jin CH Baek HJ A case of systemic lupus erythematous associated with neuromyelitis optica (Devic's Syndrome) J Korean Rheum Assoc 2007 14 2637 Wingerchuk DM Lennon VA Pittock SJ Lucchinetti CF Weinshenker BG Revised diagnostic criteria for neuromyelitis optica Neurology 2006 66 14859 Lennon VA Wingerchuk DM Kryzer TJ Pittock SJ Lucchinetti CF Fujihara K A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis Lancet 2004 364 210612 Takahashi T Fujihara K Nakashima I Misu T Miyaza-wa I Nakamura M Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO: a study on antibody titre Brain 2007 130 123543 Jarius S Aboul-Enein F Waters P Kuenz B Hauser A Berger T Antibody to aquaporin-4 inthe longterm course of neuromyelitis optica Brain 2008 131 307280 Mok CC Lau CS Chan EY Wong RW Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome J Rheumatol 1998 25 46773 Sellner J Boggild M Clanet M Hintzen RQ Illes Z Montalban X EFNS guidelines on diagnosis and management of neuromyelitis optica Eur J Neurol 2010 17 101932 Weinshenker BG O'Brien PC Petterson TM Nosewor-thy JH Lucchinetti CF Dodick DW A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease Ann Neurol 1999 46 87886 Lucchinetti CF Mandler RN McGavern D Bruck W Gleich G Ransohoff RM A role for humoral mechanisms in the pathogenesis of Devic's neuromyelitis optica Brain 2002 125 145061 Cree BA Lamb S Morgan K Chen A Waubant E Genain C An open label study of the effects of rituximab in neuromyelitis optica Neurology 2005 64 12702 Jacob A Weinshenker BG Violich I McLinskey N Krupp L Fox RJ Treatment of neuromyelitis optica with rituximab: retrospective analysis of 25 patients Arch Neurol 2008 65 14438 Figures

A 28-year-old woman diagnosed with systemic lupus erythematosus, presented with recurrent visual disturbance and sudden onset of paraplegia. (A) Sagittal T2-weighted magnetic resonance image of the cervical spine shows cord enlargement and longitudinal hyperintense lesion extending over 7 vertebral seg-ments. (B) Sagittal fat suppression T2-weighted magnetic resonance image of the cervico-thoracic spine shows a diffuse hyperintense lesion through the cervico-thoracic spine cord from C4 to T10 level.

Axial T1-weighted contrast enhanced fat suppression image of brain demonstrates subtle enhancement at the right intraorbital nerve (arrow).