Sjogren's syndrome presenting as longitudinally extensive transverse myelitis: A case report

35^th European Neurology Congress

June 14-15, 2021 Webinar

Bashir Ahmad Sanaie

Govt. Medical College Srinagar, India

Scientific Tracks Abstracts: J Neurol Disord

Abstract :

Longitudinal extensive transverse myelitis (LETM) is defined as a spinal cord lesion that extends over three or more vertebrae, as seen on MRI of the spine. Our case is a 50 year gentleman who presented with history of severe radicular pain in the upper back followed by weakness of all four limbs for two months associated with paresthesias, urinary retention and constipation. Neurological examination revealed quadriparesis with sensory level at T1, hyperreflexia and extensor plantar response. MRI of the spinal cord showed longitudinally extensive T2 lesions /hyperintensities extending from C1 to the conus medullaris. Cerebrospinal fluid examination revealed mild lymphocytic pleocytosis (20 cells) with normal sugar (53mg/dl) and raised protein (61mg/dl). CSF staining, MTB-PCR, VDRL were negative. MRI Brain was normal. Anti NMO panel (anti-Aquaporin 4 antibody and anti- MOG antibody) was negative. ANA, anti- Ro/anti- SSA and anti-La/anti-SSB were positive and anti-ds DNA was negative. Schirmer test was positive in both eyes and lip biopsy revealed focal lymphocytic sialoadenitis. A final diagnosis of LETM secondary to Sjogren’s syndrome was made. The patient was treated with intravenous methylprednisolone 1gm daily for five days. As there was no clinical improvement patient was initiated on plasmapheresis @ 250ml/kg in five sessions over a period of 10 days. Following this patient showed partial recovery in symptoms. LETM is a characteristic feature of neuromyelitis optica (NMO) but such spinal lesions can also occur in systemic autoimmune diseases like Sjogren’s syndrome.

Biography :

Bashir A Sanaie (DM, Neurology) is working as Assistant Professor and Head, Department of Neurology, Superspeciality Hospital of Govt. Medical College, Srinagar (J&K) India. Has expertise in dealing with patients of neuroinfections and is founder of Multiple Sclerosis Support Group of Kashmir. He has keen interest in patients’ awareness programs in addition to my own work as a consultant neurologist. Has been recently conferred Medical Excellence Award and Gold Medal by Indian Solidarity Council, International Award for Rising Talent in Nepal.