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Chiganer EH, Lessa CF, Di Pace JL, Perassolo MB, Carnero Contentti E, Alessandro L, Correale J, Farfan MF, Galiana GL, Sánchez Benavides M, Pacello F, Stagno M, Cardozo A, Nacimiento Cantero MB, Elizaur López JG, Delgadillo PD, Melgarejo P, Acosta Colman I, Vázquez Báez MA, Correa Díaz EP, Jácome Sánchez EC, Alva Linares M, Zamora Tehozol EA, Fragoso-Loyo HE, Quintanilla-González L, Batún-Garrido JADJ, Sato EI, do Reis-Neto ET, Carreño Nigro MA, Hryb JP. Transverse Myelitis in Systemic Lupus Erythematosus: Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients. J Clin Rheumatol 2021; 27:S204-S211. [PMID: 32028309 DOI: 10.1097/rhu.0000000000001322] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. METHODS In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). RESULTS Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. CONCLUSIONS Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.
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Affiliation(s)
| | | | | | | | | | - Lucas Alessandro
- Department of Neurology, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires
| | - Jorge Correale
- Department of Neurology, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires
| | | | | | | | - Franco Pacello
- Department of Internal Medicine, Hospital Galán y Rocha, Paysandu, Uruguay
| | - Mauro Stagno
- Department of Internal Medicine, Hospital Galán y Rocha, Paysandu, Uruguay
| | | | | | | | | | | | - Isabel Acosta Colman
- Department of Rheumatology, Hospital de Clínicas Universidad Nacional de Asunción, Asuncion, Paraguay
| | | | | | | | - Magaly Alva Linares
- Rheumatology Division, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | | | - Hilda Esther Fragoso-Loyo
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City
| | - Lauro Quintanilla-González
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City
| | | | - Emilia Inoue Sato
- Rheumatology Division, Department of Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil
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Jácome Sánchez EC, García Castillo MA, González VP, Guillén López F, Correa Díaz EP. Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review. Mult Scler J Exp Transl Clin 2018; 4:2055217318768330. [PMID: 29662683 PMCID: PMC5894926 DOI: 10.1177/2055217318768330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.
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Affiliation(s)
| | | | | | - Fernando Guillén López
- Department of Neurology, Hospital José Carrasco de Cuenca, Popayán y Pacto Andino, Ecuador
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Jácome Sánchez EC, Correa Díaz EP, Martinez Burbano B, Ortiz Yépez MA, García Castillo MA. Neurocysticercosis a public health problem. Clin Case Rep 2017; 5:543-544. [PMID: 28396789 PMCID: PMC5378834 DOI: 10.1002/ccr3.873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/22/2017] [Accepted: 01/31/2017] [Indexed: 11/22/2022] Open
Abstract
Neurocysticercosis is a parasitic disease of the central nervous system that constitutes a public health problem in endemic regions. Here, we present a patient with epilepsy and cognitive impairment due to neurocysticercosis. A public health intervention could eradicate this disease in endemic regions such as Ecuador.
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Affiliation(s)
| | - Edgar Patricio Correa Díaz
- Department of Neurology at Carlos Andrade Marin Hospital; Avenida Ayacucho y 18 de Septiembre; Quito Ecuador
| | - Braulio Martinez Burbano
- Department of Neurology at Carlos Andrade Marin Hospital; Avenida Ayacucho y 18 de Septiembre; Quito Ecuador
| | - María Angélica Ortiz Yépez
- Department of Neurology at Carlos Andrade Marin Hospital; Avenida Ayacucho y 18 de Septiembre; Quito Ecuador
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Correa Díaz EP, Jácome Sánchez EC, Martínez BA. Suicide in adolescents with depression: the need for early diagnosis. Clin Case Rep 2015; 3:962-3. [PMID: 26576283 PMCID: PMC4641485 DOI: 10.1002/ccr3.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022] Open
Abstract
Adolescent suicide is a public health problem worldwide. Parents and family play a crucial role in seeking professional help early enough to avoid catastrophic outcomes such as the death of a teenager.
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Affiliation(s)
- Edgar Patricio Correa Díaz
- Department of Neurology, Carlos Andrade Marín Hospital, San Francisco of Quito University Quito, Ecuador
| | | | - Braulio Alexander Martínez
- Department of Neurology, Carlos Andrade Marín Hospital, San Francisco of Quito University Quito, Ecuador
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