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SLE Myelitis — SCE Rheumatology MCQ

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HardRheumatology EmergenciesSLE MyelitisSCE Rheumatology

A 35-year-old woman with SLE presents with acute-onset bilateral leg weakness sensory level at T6 and urinary retention. MRI spine shows longitudinally extensive transverse myelitis affecting segments T4-T8 with cord oedema. What is the most important immediate treatment?

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Correct answer: A — IV Methylprednisolone 1 g daily for 3-5 days

Lupus myelitis is a neuropsychiatric emergency requiring immediate high-dose IV Methylprednisolone (1 g daily for 3-5 days) to reduce cord inflammation and prevent permanent neurological damage. Anti-aquaporin 4 antibodies should be checked to exclude NMOSD overlap. After pulse steroids, Cyclophosphamide or Rituximab may be considered as induction therapy. Plasma exchange can be added for refractory cases. Delay in treatment is associated with poor neurological outcomes.

Reference: EULAR 2023 SLE recommendations; ACR 1999 neuropsychiatric lupus nomenclature