We report a 48-year-old female with the history of
Sjogren's syndrome who presented with 3-week history of tingling,
numbness, and shooting back, waist, and bilateral leg
pain and
numbness in the pelvic region with urinary and
bowel incontinence. Physical examination was remarkable for reduced motor power in both lower extremities with spasticity. Sensory deficit was noted at the T6 level. Laboratory investigation revealed elevated ESR and CRP and positive serum antiaquaporin-4
IgG. Thoracic and lumbar magnetic resonance imaging revealed abnormal patchy areas, leptomeningeal enhancement through the thoracic cord extending from T3 through T6 levels, without evidence of cord compression. Impression of
neuromyelitis optica spectrum disorder was made and patient was treated with
methylprednisolone intravenously followed by tapering oral
prednisone. Neurological symptoms gradually improved with resolution of bowel and
urinary incontinence. In a patient with
Sjogren's syndrome who presents with neurological complaints, the possibility of
neuromyelitis optica or
neuromyelitis optica spectrum disorder should be considered. Awareness of the possibility of
CNS disease is important due to the serious nature of CNS complications, some of which are treatable with
immunosuppressants. Our patient with
Sjogren's syndrome who presented with
myelopathy benefited from early recognition and institution of appropriate
therapy.