Longitudinally extensive transverse myelitis as a manifestation of neuro-chikungunya in a lupus patient: a case report.

Background: Myeloneuropathy is rare complication of Chikungunya virus (CHIKV) infection which may have an underlying immune-mediated pathogenesis.

Case Presentation: We describe a 31-year old female patient with systemic lupus erythematosus (SLE) presenting with acute/hyperacute bulbar and medullary fever syndrome with ascending tetraparesis associated with arthritis, requiring differential diagnosis. The analysis of the cerebrospinal fluid (CSF) revealed inflammatory markers, high protein levels, high lymphocyte and neutrophil counts, and reduced glucose. Neuroimaging showed amorphous foci of hyperintensity in T2, suggesting extensive medullary edema, especially in the central region, with no significant contrast enhancement, along with areas of medullary atrophy consistent with holocord longitudinally extensive transverse myelitis and periventricular and periaqueductal involvement. CHIKV IgM antibodies were also detected in the CSF.

Conclusion: The present case highlights the importance of investigating atypical neurological syndromes in SLE and of including CHIKV infection, though rare, in the differential diagnosis of patients from endemic regions in order to minimize morbidity and mortality.