Transverse myelitis by Zika virus in patient with Systemic Lupus Erythematosus (SLE) - case report in Manaus - AM

Objective: case report of a patient with transverse myelitis diagnosed with systemic lupus erythematosus and zika Virus. Case report: Patient diagnosed with Systemic Lupus Erythematosus (SLE) with class IV lupus nephritis for 15 years in remission, begins to have diffuse myalgia, impairing walking. After spontaneous improvement of the condition, the patient remained complaining of asthenia and recurrent left unilateral severe headache, evolving with syncope, progressive ascending paraparesis in the lower limb, followed by a generalized tonic clonic seizure type of disruptive onset. A first examination of the cerebrospinal fluid (CSF) was requested, without evidence of alteration in the simple biochemical analysis. Other laboratory alterations were identified, in addition to the polymerase chain reaction (PCR) for detectable Zika virus in urine and cerebrospinal liquor (after collection). Changes were detected on magnetic resonance imaging (MRI) compatible with transverse myelitis. The etiological investigation lasted two and a half months, with two hospitalizations in the period. Although the neurological manifestations of Zika Virus are ordinarily nonspecific, rare and mild, the diagnostic hypothesis of transverse myelitis in an endemic area for arboviruses with neurological manifestations should not be disregarded even after cerebrospinal fluid and unspecific with the other clinical, remissive of the clinical picture lupus erythemasous systemic 15 years ago.