case_images: PMC11211561_01
case_images: Overview of the patient's clinical course. The solid lines represent the presence of symptoms, with the length of the lines indicating symptom duration. The dotted lines represent a partial alleviation of symptoms. Transverse myelitis due to neuromyelitis optica spectrum disorder (NMOSD) improved following the initiation of intravenous methylprednisolone (IVMP), plasma exchange (PLEX), and rituximab, although the patient has had ongoing urinary frequency and erectile dysfunction. Juvenile dermatomyositis (JDM)-related polyarthritis improved with the addition of methotrexate; however, he had persistent cutaneous disease prompting the addition of intravenous immunoglobulin (IVIG) and hydroxychloroquine.
case_images: fped-12-1376088-g001.jpg
case_images: PMC11211561_01_fped-12-1376088-g001.jpg
case_images: F1
case_images: Approximately 5 months prior to presentation, a 17-year-old Vietnamese male developed dry patches on his hands, lower back, and abdomen, which was initially treated as possible atopic dermatitis (clinical course summarized in Figure 1).
case_images: Physical exam findings at the time of initial evaluation by pediatric rheumatology. Erythema was seen overlying multiple knuckles and the distal fingertips without associated papules or nodules. There was polyarthritis of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints bilaterally. He would eventually develop a more classic pattern of Gottron papules (erythema over MCPs with associated papular eruption).
case_images: fped-12-1376088-g002.jpg
case_images: PMC11211561_01_fped-12-1376088-g002.jpg
case_images: F2
case_images: On initial presentation to pediatric rheumatology, his exam was notable for symmetric polyarthritis affecting more than 30 small and large joints, discrete patches of hyperpigmentation on his posterior shoulder blades and lower back, erythema overlying multiple knuckles and the dorsal aspect of his distal fingertips, but without associated papules or ulcers (Figure 2), alopecia, and significant weight loss (~8 kg).
case_images: Imaging at the time of presentation to the emergency department. MRI demonstrated extensive T2 signal abnormality involving nearly the entire spinal cord, with hazy enhancement from C5 to T5, as can be seen with transverse myelitis.
case_images: fped-12-1376088-g003.jpg
case_images: PMC11211561_01_fped-12-1376088-g003.jpg
case_images: F3
case_images: C5-T5 spinal cord enhancement was observed (Figure 3) concerning for transverse myelitis.