Myelopathy manifested clinically as acute longitudinal or transverse myelitis 
constitutes one of the most severe and rare neuropsychiatric manifestations of 
systemic lupus erythematosus (SLE) (1-3% of patients). Myelitis has been 
observed less commonly in other connective tissue diseases, mostly in 
antiphospholipid syndrome, and rarely in Sjögren's syndrome, Behçet's disease 
and mixed connective tissue disease. Acute transverse myelitis (ATM) may also be 
present in diseases of various etiology, including multiple sclerosis, 
sarcoidosis, infectious diseases and malignancies. Myelitis in SLE is manifested 
as a dramatic spinal cord injury leading to paralysis or muscular paresis, 
sensory deficits, and smooth muscle dysfunction usually in the form of sphincter 
dysfunction. The imaging technique of choice in case of suspected ATM is 
magnetic resonance imaging with intravenous contrast agent (gadolinium 
diethylenetriamine-pentaacid). Cerebrospinal fluid (CSF) examination in patients 
with ATM in the course of SLE indicate usually pleocytosis with prevalence of 
granulocytes, increased protein levels, low glucose levels, significantly 
hindering differential diagnosis in the early stage of the disease. Observations 
made by the authors (2 female patients with SLE) show that antibodies specific 
to SLE can be found in the CSF collected in the acute phase of myelitis. These 
observations have not yet been confirmed by other researchers. Early 
introduction of intravenous immunosuppression with large doses of 
cyclophosphamide and glucocorticosteroids improves the long-term prognosis. 
Other therapeutic approaches have been also used in more severe cases. Even with 
appropriate therapy, prognosis in this disease is uncertain.