Maryrose Zavaro, MMSc
Medical Student OMS IV
LECOM
El Cajon, California, United States
Richard Martirosian, MD
Resident Physician PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Emmanuel Villalpando, MD
Resident Physician PGY-2
Casa Colina
Winnetka, California, United States
Hunter Goldsmith, MD
PGY2
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Brian Vu, MD
Resident Physician
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
Ethan Izu, BS
Medical Student
California University of Science and Medicine
Irvine, California, United States
Phillip Ahn, BS
Medical Student
Western University
Irvine, California, United States
Justin Phillips, MD, FAAPMR
Program Director of PM&R
Casa Colina Hospital and Centers for Healthcare
Pomona, California, United States
We present a case of a 34-year-old male with neuromyelitis optica exacerbation and systemic lupus erythematosus highlighting challenges in managing functional mobility and pain which required multidisciplinary rehabilitation.
Case Description:
A 34-year-old male presented with bilateral leg weakness, impaired sensation, and urinary retention. MRI showed long-segment T2 hyperintensity in the spinal cord. Aquaporin-4 antibodies confirmed neuromyelitis optica. Initial treatment included intravenous steroids, IVIG, and plasmapheresis. Renal failure prompted a kidney biopsy revealing lupus nephritis. The patient began a six-week prednisone taper and atovaquone prophylaxis. Due to deconditioning, intensive inpatient rehabilitation focused on mobility, strength, and self-care. Bladder management included intermittent catheterization. Pain and spasticity were managed with baclofen, oxycodone, and gabapentin. These comprehensive interventions addressed the patient’s functional limitations and enhanced quality of life.
Discussions: Systemic lupus erythematosus can present with neurological manifestations similar to neuromyelitis optica complicating rehabilitation due to overlapping pathophysiology and severe impairment risk. A multidisciplinary approach involving neurology, nephrology, rheumatology, and rehabilitation is essential for optimizing patient outcomes. Combined disease-modifying therapies and targeted rehabilitation highlights the need for integrated care. Managing pain, spasticity, and bladder function requires individualized strategies. Further research is needed to develop protocols for long-term outcomes and quality of life in patients with systemic lupus erythematosus and neuromyelitis optica.
Conclusions: Rehabilitation of patients with transverse myelitis induced by systemic lupus erythematosus and neuromyelitis optica requires a multidisciplinary, individualized approach to manage complex symptoms, enhance functional independence, and improve quality of life.
