Myélopathie lupique

Neurological manifestations of systemic lupus erythematosus (SLE) are common and severe. However, myelopathy is rarely reported (1-2 % of cases). We describe SLE in a 24-year-old women who presented with acute paraplegia and sphincter incontinence. Spinal cord MRI revealed intramedullary diffuse and heterogenic high intensity signal. CSF study showed pleocytosis and increased protein. Antinuclear, anti-DNA and antiphospholipid antibodies were positive. High-dose intravenous steroids, oral steroid, cyclophosphamide pulse and antiplatelet drugs were given. The pathophysiological mechanisms of myelopathy in SLE are uncertain, antiphospholipid antibodies may be a cause of thrombosis and ischemic myelopathy. It has also been suggested that auto-antibodies directed against central nervous system cells could be involved.