A case report of transverse myelopathy associated with systemic lupus erythematosus with positive antiphospholipid antibody

In November 1986, a 37-year-old female patient was diagnosed as systemic lupus erythematosus (SLE) because of photosensitivity, butterfly rash, positive antinuclear antibody and positive anti DNA antibody, and thereafter she had been treated with prednisolone in the department of dermatology of our college. In Decemmber 1989, she was transferred to our department because of general fatigue and paresis in her both legs. The titers of antinuclear antibody were 1 to 2,560 and anticar-diolipin (aCL) antibody were a titer of 73 U/ml. Her head CT scan showed multiple cerebral infarction and she was treated with prednisolone at initial dosage of 40 mg per day with a slight improvement of clinical symptoms. However, she stopped taking prednisolone by her own will. In May 1990, she was re-admitted because of complete paralysis and sensory disturbance on her both feet and vesico-urethral disturbance with a high titer of aCL antibody (94 U/ml). She was diagnosed as transverse myelopathy associated with SLE with positive aCL antibody. Treatments of pulse therapy with methylprednisolone, oral administration of cyclophosphamide, intravenous administration of γ-globulin as large as 15 g per day for 5 days, and plasma exchange were not effective on neurological symptoms, in spite of decreased titer of aCL. Early treatment seemed to be necessary for clinical improvement of transverse myelopathy.