Mielopatia transversa e lupus eritematoso sistemico: registro de um caso e revisão da literatura

macedo, Djacir dantas pereira de; Mattos, James Pitagoras de; Borges, Tania Maria Menezes

doi:10.1590/S0004-282X1979000100011

Resumos

Os autores apresentam caso de mielopatia transversa no curso de lupus eritematoso sistêmico de evolução sub-aguda e êxito letal. É feita revisão da literatura e são abordados aspectos clínicos, laboratoriais, terapêuticos e anátomo-patológicos. São ressaltados a precariedade dos resultados terapêuticos e a provável participação de fatores auto-imunes, levando a processos de desmielinização e que se constituíram, ao lado do clássico comprometimento vascular, nos substratos anátomo-patológicos das manifestações neurológicas do lupus eritematoso sistêmico. Os autores acreditam, fundamentados em dados evolutivos, na existência de processo desmielinizante no caso relatado, embora a necrópsia não tenha sido autorizada.

A case of transverse myelopathy in systemic lupus erythematosus with subacute onset and fatal course is reported. A review of the literature is done and clinical, laboratorial, therapeutics and pathological aspects are discussed. The authors call attention to the poor results of therapy and discuss the participation of immunological factors leaving to demyelination which are, aside the classical vascular involvment, the probable mechanisms in the neurological manifestations of systemic lupus erythematosus. The authors believe that, in their case, such a demyelinative mechanism was responsable for the clinical picture, although a necroscopic examination was not allowed.

Mielopatia transversa e lupus eritematoso sistemico: registro de um caso e revisão da literatura

Transverse myelopathy and systemic lupus erythematosus: a case report and review of the literature

Djacir dantas pereira de macedo^I; James Pitagoras de Mattos^II; Tania Maria Menezes Borges^III

^IAuxiliar de Ensino da Faculdade de Medicina da UFRN, mestrando em Neurologia pela UFRJ

^IIProfessor Assistente de Neurologia. Instituto de Neurologia Deolindo Couto, da UFRJ (Serviço do Prof. Bernardo Couto)

^IIIMédica-residente. Instituto de Neurologia Deolindo Couto, da UFRJ (Serviço do Prof. Bernardo Couto)

RESUMO

Os autores apresentam caso de mielopatia transversa no curso de lupus eritematoso sistêmico de evolução sub-aguda e êxito letal. É feita revisão da literatura e são abordados aspectos clínicos, laboratoriais, terapêuticos e anátomo-patológicos. São ressaltados a precariedade dos resultados terapêuticos e a provável participação de fatores auto-imunes, levando a processos de desmielinização e que se constituíram, ao lado do clássico comprometimento vascular, nos substratos anátomo-patológicos das manifestações neurológicas do lupus eritematoso sistêmico. Os autores acreditam, fundamentados em dados evolutivos, na existência de processo desmielinizante no caso relatado, embora a necrópsia não tenha sido autorizada.

SUMMARY

A case of transverse myelopathy in systemic lupus erythematosus with subacute onset and fatal course is reported. A review of the literature is done and clinical, laboratorial, therapeutics and pathological aspects are discussed. The authors call attention to the poor results of therapy and discuss the participation of immunological factors leaving to demyelination which are, aside the classical vascular involvment, the probable mechanisms in the neurological manifestations of systemic lupus erythematosus. The authors believe that, in their case, such a demyelinative mechanism was responsable for the clinical picture, although a necroscopic examination was not allowed.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Instituto de Neurologia Deolindo Couto, da UFRJ (Serviço do Prof. Bernardo Couto).

Instituto de Neurologia Deolindo Couto - Av. Wenceslau Brás, 95, Botafogo -22290 Rio de Janeiro, RJ - Brasil.

1. AITA, J. A. - Neurological Manifestations of General Diseases. Charles C. Thomas, Springfield (Illinois), 1972.
2. ANDRIANAKOS, A. A.; DUFY, J.; SUZUKI, M. & SHARP, J. T. - Transverse myelopathy in systemic lupus erythematosus. Ann. Int. Med. 83:616, 1975.
3. APRIL, R. & VANSONNENBERG, E. - A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus. Neurology (Minneapolis) 26:1066, 1976.
4. ATKINS, G. F.; KONDON Jr., J. J.; QUISMORIO, F. P. & FRIOU G. F. -The choroid plexus in systemic lupus erythematosus. Ann. Int. Med. 76:65, 1972.
5. BENNETT, R.; HUGHES, G. R. W.; BYWATERS, E. G. L. & HOLT, P. J. L. -Neuropsychiatric problems in systemic lupus erythematosus. British Med. J. 4:342, 1972.
6. CHINI, G. - As manifestações neurológicas do lupus eritematoso sistêmico. Tese, Faculdade de Medicina da UFRJ, 1970.
7. CLARK, E. C. & BAYLEY, A. A. - Neurological and psychiatric signs associated with systemic lupus erythematosus. J. A. M. A. 160:455, 1956.
8. DALY, D. - Central nervous system in acute disseminated lupus erythematosus. J. Nerv. Ment. Dis. 102:461, 1945.
9. DUBOIS, E. L. - The clinical picture of systemic lupus erythematosus. In Lupus Erythematosus - E. L. Dubois, ed., McGraw Hill, New York, 1966.
10. DUBOIS, E. L. - Prednisone and prednisolone in the treatment of systemic lupus erythematosus. J. A. M. A. 161:427, 1952.
11. DUBOIS, E. L.; WIERCHOWIECKI, M. COX, M. B. & WEINWR, J. M. -Duration and death in systemic lupus erythematosus. J. A. M. A. 227:1399, 1974.
12. ESTES, D. & CHRISTIAN, C. L. - The natural history of systemic lupus erythemarosus by prospective analysis. Medicine 61:85, 1971.
13. EPSTEIN, W. V. - Laboratory tests in rheumatic diseases. Med. Clin. N. Amer. (Philadelphia) 61:377, 1977.
14. FRIES, J. F. - The clinical aspects of systemic lupus erythematosus. Med. Clin. N. Amer. (Philadelphia) 61:229, 1977.
15. FULTON, W. H. & DYKEN, P. R. - Neurological syndromes of systemic lupus erythematosus. Neurology (Minneapolis) 14:317, 1964.
16. GIBSON T. & MYERS, A. R. - Nervous system involvement in systemic lupus erythematosus. Ann. Rheum. Dis. 35:398, 1976.
17. GLASER, G. H. - Lesions of the central nervous system in disseminated lupus erythematosus. Arch. Neurol. & Psychiat. (Chicago) 67:745, 1952.
18. GRANGER, D. P. - Transverse myelopathy with recovery: the only manifestation of systemic lupus erythematosus. Neurology (Minneapolis) 10:325, 1960.
19. HUGHES, G. R. V.; COHEN, S. A. & CHRISTIAN, G. C. - Anti-DNA activity in systemic lupus erythematosus: a diagnotic and therapeutic guide. Ann. Rheum. Dis. 30:259, 1971.
20. JOHNSON, T. R. & RICHARDSON, E. P. - The neurological manifestations of systemic lupus erythematosus. Medicine 47:337, 1968.
21. KEEFE, E. B.; BARDANA, E. J.; HARBECK, J. R.; PIROFSKY, B. & CARR, R. I. - Lupus meningitis - Antibody to DNA and DNA: Anti-DNA complexes in cerebrospinal fluid. Ann. Int. Med. 80:58, 1974.
22. LEVO, Y.; PICK, A. I.; KALACI, J. & GOLOMB, M. - Correlation between anti-DNA antibody titres and psychiatric manifestations. Post-Grad. Med. J. 52:759, 1976.
23. MALAMUD, N. & SAVER, G. - Neuropathological findings in disseminated lupus erythematosus. Arch. Neurol. & Psychiat. (Chicago) 71:723, 1954.
24. O'CONNOR, J. F. & MUSHER, D. M. - Central nervous system in systemic lupus erythematosus: a study of 150 cases. Arch. Neurol. (Chicago) 14:157, 1966.
25. PENN, A. S. & ROWAN, A. J. - Myelopathy in systemic lupus erythematosus. Arch. Neurol. (Chicago) 18:337, 1968.
26. PETZ, L. D.; SHARP, S. C; COOPER, N. R. & IRVIN, W. S. - Serum and cerebrospinal fluid complement and serum antibodies in systemic lupus erythematosus. Medicina 50:259, 1971.
27. PIPER, P. G. - Disseminated lupus erythematosus with involvement of the spinal cord. J. A. M. A. 153:215, 1953.
28. PIROFSKY, B. & BARDANA Jr., E. J. - Immunossupressive theraphy in rheumatic disease. Med. Clin. N. Amer. (Philadelphia) 61:411, 1977.
29. PONS, A. P.; ROZMAN, C; SAN MIGUEL J. G.; VIDAL, M. T. & CIACAR, F. - Lupus eritematoso disseminado. In Patologia y Clínica de las Colagenosis Pons, A. P., ed., Ediciones Toray, Barcelona, 1967.
30. VERZTMAN, L.; GALO, A. M.; FINKEL, N.; GUIMARÃES, S.; RUBINSTEIN, J.; LEDERMAN, R.; ATHAYDE, M. C. & SILVA, P. R. N. - Mielopatia em paciente portador de associação de LES e esclerose sistêmica. Rev. Brasil. Reumatol. 17:27, 1977.

Datas de Publicação

Publicação nesta coleção
27 Ago 2012
Data do Fascículo
Mar 1979

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AITA, J. A. - Neurological Manifestations of General Diseases. Charles C. Thomas, Springfield (Illinois), 1972.

[2] 2. ANDRIANAKOS, A. A.; DUFY, J.; SUZUKI, M. & SHARP, J. T. - Transverse myelopathy in systemic lupus erythematosus. Ann. Int. Med. 83:616, 1975.

[3] 3. APRIL, R. & VANSONNENBERG, E. - A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus. Neurology (Minneapolis) 26:1066, 1976.

[4] 4. ATKINS, G. F.; KONDON Jr., J. J.; QUISMORIO, F. P. & FRIOU G. F. -The choroid plexus in systemic lupus erythematosus. Ann. Int. Med. 76:65, 1972.

[5] 5. BENNETT, R.; HUGHES, G. R. W.; BYWATERS, E. G. L. & HOLT, P. J. L. -Neuropsychiatric problems in systemic lupus erythematosus. British Med. J. 4:342, 1972.

[6] 6. CHINI, G. - As manifestações neurológicas do lupus eritematoso sistêmico. Tese, Faculdade de Medicina da UFRJ, 1970.

[7] 7. CLARK, E. C. & BAYLEY, A. A. - Neurological and psychiatric signs associated with systemic lupus erythematosus. J. A. M. A. 160:455, 1956.

[8] 8. DALY, D. - Central nervous system in acute disseminated lupus erythematosus. J. Nerv. Ment. Dis. 102:461, 1945.

[9] 9. DUBOIS, E. L. - The clinical picture of systemic lupus erythematosus. In Lupus Erythematosus - E. L. Dubois, ed., McGraw Hill, New York, 1966.

[10] 10. DUBOIS, E. L. - Prednisone and prednisolone in the treatment of systemic lupus erythematosus. J. A. M. A. 161:427, 1952.

[11] 11. DUBOIS, E. L.; WIERCHOWIECKI, M. COX, M. B. & WEINWR, J. M. -Duration and death in systemic lupus erythematosus. J. A. M. A. 227:1399, 1974.

[12] 12. ESTES, D. & CHRISTIAN, C. L. - The natural history of systemic lupus erythemarosus by prospective analysis. Medicine 61:85, 1971.

[13] 13. EPSTEIN, W. V. - Laboratory tests in rheumatic diseases. Med. Clin. N. Amer. (Philadelphia) 61:377, 1977.

[14] 14. FRIES, J. F. - The clinical aspects of systemic lupus erythematosus. Med. Clin. N. Amer. (Philadelphia) 61:229, 1977.

[15] 15. FULTON, W. H. & DYKEN, P. R. - Neurological syndromes of systemic lupus erythematosus. Neurology (Minneapolis) 14:317, 1964.

[16] 16. GIBSON T. & MYERS, A. R. - Nervous system involvement in systemic lupus erythematosus. Ann. Rheum. Dis. 35:398, 1976.

[17] 17. GLASER, G. H. - Lesions of the central nervous system in disseminated lupus erythematosus. Arch. Neurol. & Psychiat. (Chicago) 67:745, 1952.

[18] 18. GRANGER, D. P. - Transverse myelopathy with recovery: the only manifestation of systemic lupus erythematosus. Neurology (Minneapolis) 10:325, 1960.

[19] 19. HUGHES, G. R. V.; COHEN, S. A. & CHRISTIAN, G. C. - Anti-DNA activity in systemic lupus erythematosus: a diagnotic and therapeutic guide. Ann. Rheum. Dis. 30:259, 1971.

[20] 20. JOHNSON, T. R. & RICHARDSON, E. P. - The neurological manifestations of systemic lupus erythematosus. Medicine 47:337, 1968.

[21] 21. KEEFE, E. B.; BARDANA, E. J.; HARBECK, J. R.; PIROFSKY, B. & CARR, R. I. - Lupus meningitis - Antibody to DNA and DNA: Anti-DNA complexes in cerebrospinal fluid. Ann. Int. Med. 80:58, 1974.

[22] 22. LEVO, Y.; PICK, A. I.; KALACI, J. & GOLOMB, M. - Correlation between anti-DNA antibody titres and psychiatric manifestations. Post-Grad. Med. J. 52:759, 1976.

[23] 23. MALAMUD, N. & SAVER, G. - Neuropathological findings in disseminated lupus erythematosus. Arch. Neurol. & Psychiat. (Chicago) 71:723, 1954.

[24] 24. O'CONNOR, J. F. & MUSHER, D. M. - Central nervous system in systemic lupus erythematosus: a study of 150 cases. Arch. Neurol. (Chicago) 14:157, 1966.

[25] 25. PENN, A. S. & ROWAN, A. J. - Myelopathy in systemic lupus erythematosus. Arch. Neurol. (Chicago) 18:337, 1968.

[26] 26. PETZ, L. D.; SHARP, S. C; COOPER, N. R. & IRVIN, W. S. - Serum and cerebrospinal fluid complement and serum antibodies in systemic lupus erythematosus. Medicina 50:259, 1971.

[27] 27. PIPER, P. G. - Disseminated lupus erythematosus with involvement of the spinal cord. J. A. M. A. 153:215, 1953.

[28] 28. PIROFSKY, B. & BARDANA Jr., E. J. - Immunossupressive theraphy in rheumatic disease. Med. Clin. N. Amer. (Philadelphia) 61:411, 1977.

[29] 29. PONS, A. P.; ROZMAN, C; SAN MIGUEL J. G.; VIDAL, M. T. & CIACAR, F. - Lupus eritematoso disseminado. In Patologia y Clínica de las Colagenosis Pons, A. P., ed., Ediciones Toray, Barcelona, 1967.

[30] 30. VERZTMAN, L.; GALO, A. M.; FINKEL, N.; GUIMARÃES, S.; RUBINSTEIN, J.; LEDERMAN, R.; ATHAYDE, M. C. & SILVA, P. R. N. - Mielopatia em paciente portador de associação de LES e esclerose sistêmica. Rev. Brasil. Reumatol. 17:27, 1977.