We present the case of a 35-year-old man, without morbid conditions, who debuts with a clinical picture of 6 months of evolution, characterized by a sensation of last electrical current in the right hemiparesis (sign 5/5mitte).
Cervical MRI showed extensive transverse myelitis from C2 to C6 with gadolinium coating.
Anti-dl booster, anti-NAA (+) 1:1,280 mottled pattern with perinuclear, anti-double-stranded DNA (+) 1,046.5 IU/ml, anti-Sm/RNP 124
Anti-Scl 70, Jo-1, anti-Psychrosomal, and antiphospholipid syndrome negative study.
Lymphopenia up to 500/uL prior to treatment stood out, and the rest of the blood count was normal.
There were no clinical, articular or renal manifestations.
HIV ELISA (-), non-reactive VDRL.
A rheumatologist diagnosed systemic lupus erythematosus (SLE) with secondary Sjögren's syndrome.
Therapy with boluses of methylprednisolone 1 g ev per day for 5 days was initiated, with regular clinical response due to evolution to tetraparesis M4-/5, reason why it was decided to start distal pulses with good cyclophosphamide.
Three months after diagnosis she presented a second sprout characterized by left optic neuritis and ataxia, treated with boluses of methylprednisolone 1 g ev per day for 5 days, with complete resolution of symptoms.
She developed neuropatic pain, starting pregabalin up to 450 mg and frequent flexor spasms, treated with baclofen up to 60 mg daily.
The patient was evaluated on an outpatient basis at the eighth month of diagnosis with 8 cycles of cyclophosphamide (dose of cyclophosphamide) and right-sided spasms, with notable improvement in neuropatic pain, flexors, and minimal anti-brachiocrural paresis
A control cervical MRI showed remnant hypersignal in the posterior cords from C2 to C4 and punctiform reinforcement with gadolinium.
At the tenth month of diagnosis she presented a third sprout: ataxia propionate and right brachiocrural hemiapresis M4-/5.
Brain and spinal cord MRI showed hyperintensity on T2 and left frontal subcortical FLAIR, with gadolinium nodular reinforcement of the left precentral lesion was observed.
At the spinal cord level, hypersignal foci were found between C2 and C5 and from C6-C7 to T3.
She was admitted to the neurological intermediate for pulse intravenous methylprednisolone 1 g for 5 days.
The case was discussed among the teams of neurology and rheumatology with rituximab, characterized by a second-line response with rituximab 700 mg ev the first cycle, later with cycles every 6 months of 500 mg ev at a time, complete spasm
