J Korean Rheum Assoc.  2007 Mar;14(1):78-84. 10.4078/jkra.2007.14.1.78.

Demyelinating Syndrome Resembling Multiple Sclerosis as the First Manifestation of Systemic Lupus Erythematosus: Report of Two Cases

  • 1Departments of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea. k6704@chollian.net
  • 2Departments of Neurology, Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 3Departments of Radiology, Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea.


Neurologic manifestations rarely occur as presenting feature of systemic lupus erythematosus (SLE). We describe two women who presented with several episodes of neurologic symptoms mimicking multiple sclerosis. Several years after disease onset, clinical and laboratory finding were compatible with SLE. These cases show that demyelinating syndrome resembling multiple sclerosis may present as a first manifestation of SLE.


Multiple sclerosis; Systemic lupus erythematosus; Demyelinating syndrome

MeSH Terms

Lupus Erythematosus, Systemic*
Multiple Sclerosis*
Neurologic Manifestations


  • Fig. 1. Axial FLAIR weighted brain MRI shows multiple high signal intensity lesions at the periaqueductal gray matter (arrowhead), uncus (thin arrow), third ventricle wall (thick arrow).

  • Fig. 2. Sagittal T2-weighted spinal MRI shows high signal intensity lesion in spinal cord at the level of C2-4.

  • Fig. 3. Axial FLAIR weighted brain MRI shows bilateral high signal intensity involving the posterior portion of the medulla.

  • Fig. 4. Axial FLAIR weighted brain MRI shows multiple high signal intensity lesions at the hypothalamus (arrow head), uncus (thin arrow), and basal ganglia (thick arrow).


1). Daniel JW. Systemic lupus erythematosus and the nervous system. In:. Daniel JW, Berva HH, editors. eds.Dubois'lupus erythematosus. 6th ed.p. 694–731. Philadelphia, Lippincott williams and wilkins;2002.
2). Kovacs B., Laferty TL., Brent LH., DeHoratius RJ. Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature. Ann Rheum Dis. 2000. 59:120–4.
3). ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999. 42:599–608.
4). Noseworthy JH., Lucchinetti C., Rodriguez M., Wein-shenker BG. Multiple sclerosis. N Eng J Med. 2000. 343:938–52.
5). Ferreira S., D'Cruz1 DP., Hughes GRV. Multiple sclerosis, neuropsychiatric lupus and antiphospholipid syndrome: where do we stand? Rheumatology. 2005. 44:434–42.
6). Theodoridou A., Settas L. Demyelination in rheumatic disease. J Neurol neurosurg psychiatry. 2006. 77:290–5.
7). 한창완: 강성욱: 차훈석: 이윤종: 송영욱. 다발성경화증과유사한임상양상으로발현된전신성홍반성루푸스1 예. 대한류마티스학회지. 1997. 4:180–4.
8). 이지현: 이기주: 윤성호: 부귀범: 손현화: 박유환등. Systemic lupus erythematosus를동반한multiple sclerosis. 조선의대논문집. 1998. 23:347–52.
9). Kira J. Goto I: Recurrent opticomyelitis associated with anti-DNA antibody. J Neurol Neurosurg Psychiatry. 1994. 57:1124–5.
10). Giorgi D., Balacco G., Bonomo L. The association of optic neuropathy with transverse myelitis in systemic lupus erythematosus. Rheumatology. 1999. 38:191–2.
11). April RS., Vansonnenberg E. A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus. Clinicopathologic report and review of the literature. Neurology. 1976. 26:1066–70.
12). Allen IV., Millar JH., Kirk J., Shillington RK. Systemic lupus erythematosus clinically resembling multiple sclerosis and with unusual pathological and ultrastructural features. J Neurol Neurosurg Psychiatry. 1979. 42:392–401.
13). Provenzale J., Bouldin TW. Lupus-related myelopathy: report of three cases and review of the literature. J Neurol Neurosurg Psychiatry. 1992. 55:830–5.
14). Galindo-Rodriquez G., Avina-Zubieta JA., Diaz de Leon V., Sauedo N., Fuentes M., Lavalle C. Cyclophophamide pulse therapy in optic neuritis due to systemic lupus erhythematosus: an open trial. Am J Med. 1999. 106:65–9.
15). Efrain DJ. Systemic lupus erythematosus induced by therapy with interferon-b in a patient with multiple sclerosis. Lupus. 2005. 14:495–6.
Full Text Links
  • JKRA
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr