Acute pneumococcal myelitis in an adult patient

Longitudinally extensive transverse myelitis with anti-NMDA receptor antibodies during a systemic lupus erythematosus flare-up

Transverse myelitis (TM) with systemic lupus erythematosus (SLE) has been linked to the presence of autoantibodies (eg, antiaquaporin 4 (AQP4) and anticardiolipin (aCL)) and SLE-induced secondary vasculitis, but the aetiology remains incompletely understood. A 48-year-old Japanese man with a 6-year history of poorly controlled SLE had stopped glucocorticoid therapy 1 year before admission. 3 days before admission, he developed flaccid paraplegia. Spinal MRI showed a longitudinally hyperintense T2 grey matter lesion from the level of Th4 to the conus medullaris, which was considered longitudinally extensive TM (LETM). We administered steroid pulse therapy (methyl-prednisolone 1000 mg/day) for 3 days and prednisolone 50 mg/day. The patient's flaccid paralysis gradually improved. We concluded that the patient's TM was caused by SLE flare-up, even though we could not completely rule out antiphospholipid syndrome. SLE myelitis is relatively rare and many aetiologies are possible for TM in SLE.

[Tetraplegia revealing a severe pneumococcal meningomyelitis: about a case and literature review]

L'atteinte médullaire est une complication rare des méningites à streptocoque pneumoniae. notre observation clinique décrit le cas d'une Jeune femme immunocompétente qui s'est présentée au service d'accueil des urgences pour tétraplégie dont les investigations ont mis en évidence une méningite à pneumocoque. Le traitement était basé sur l'antibiothérapie plus une corticothérapie concomitante. L’évolution était marquée par la persistance des séquelles neurologiques.