In the context of SLE, longitudinally extensive cord signal abnormality with smooth mild leptomeningeal enhancement most likely represents SLE related transverse myelitis or NMO spectrum disorder. Viral/post viral transverse myelitis is also a differential.

Laboratory investigations:

  • ESR 97 (2-12)
  • double stranded DNA antibodies 358 IU/mL (0-4)
  • C3/C4 low
  • EBV/CMV/HBV/mycoplasma/HIV serology - no evidence infection
  • NMO serology - negative