416 - Transverse Myelitis Following Right Ankle Surgery Potentially Unmasking Systemic Lupus Erythematosus

Case Diagnosis: Transverse Myelitis Following Right Ankle ORIF Potentially Unmasking SLE

Case Description: A 70-year-old female underwent ORIF of her right ankle following a mechanical trip and fall two weeks prior to hospital admission. Past medical history was significant only for hyperlipidemia. Two weeks following surgery, the patient experienced sudden onset bilateral anterior thigh paresthesias and burning mid-back pain. Over the ensuing two days, the patient developed bilateral lower extremity weakness, bilateral lower extremity numbness, and urinary retention with constipation which led to hospital presentation. A non-contrast cervical/thoracic/lumbar spine MRI on hospital day 1 revealed a possible syrinx from T3-T12. A repeat thoracic spine MRI on hospital day 3 revealed enhancement of the spinal cord at T9-T10 and T11-T12 suggestive of transverse myelitis or spinal cord infarction (SCI). Initiation of IV methylprednisolone sodium succinate (MPSS) improved strength and sensation and a 5-day course of IVIG therapy was initiated. The patient responded well to these medications and was discharged to inpatient rehabilitation.

Discussions: Transverse myelitis (TM) is an uncommon condition that typically occurs in the second or fourth decade of life and has an incidence of only 1-8 cases per million per year1. It is typically idiopathic or attributed to infectious causes, systemic autoimmune conditions, or central nervous system disease1. SCI remained high on the differential diagnosis considering TM rarely presents in the postoperative period2,3. While MPSS is first-line treatment for TM, its role remains unclear in treating SCI4,5. Given the patient’s positive response to MPSS, an autoimmune panel was sent to determine the underlying etiology which resulted in a positive ANA and positive anti-dsDNA. Thus, TM may be an initial presentation of SLE.

Conclusions: In rare cases of SCI versus immune-mediated disorders affecting the spinal cord, corticosteroid treatment should be considered pending diagnosis confirmation.