AUTHOR=Rodrigues Emanuelle de Matos , Fontenelle Lysiane Maria Adeodato Ramos , MontAlverne Andrea Rocha de Saboia , Gomes Kirla Wagner Poti , Studart Samia Araújo de Sousa , Neri Beatriz Rodrigues , Rodrigues Carlos Ewerton Maia 

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1600806

DOI=10.3389/fmed.2025.1600806

ISSN=2296-858X

ABSTRACT=BackgroundMyeloneuropathy is rare complication of Chikungunya virus (CHIKV) infection which may have an underlying immune-mediated pathogenesis.Case presentationWe 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.ConclusionThe 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.