>From what I have read transverse myelitis is a very rare complication of
Lupus. In fact, the cases I have read about, TM was the first major
symptom of Lupus. I haven't read of any cases where the onset of TM was
after a diagnosis of Lupus.
TM doesn't actually involve the "spine" or the vertebrae, but the
covering of the spinal cord itself. It mimics Multiple Sclerosis in a
lot of ways and they are researching the relationship, if any, to MS.
I will check out the book you recommended. I appreciate your response.
Best of luck to
you.
Please!!!!!!!!!!! Also one of your posts to the same thread about
your claimant. Posted by: rustyspfd(AT)msn.com (LuAnn)
Oh, my, what questions!!!!! I am an insurance adjuster who has been
struggling with this. I am not a nurse; however, have had an excellent
RN, CCM working with me on this.
Let me see what I can tell you, then I'll post another response once I
talk with my CM.
C: approximately 10 days between the tetnaus shot and TM. initially
case was turned in as "trauma" from an injury while working or as a
result of a manipulation from a D. O. as a result of this "trauma".
Lupus dx made within a week of the onset of TM. However, it has never
been followed up. No additional testing made or any treatment provided
because of the Lupus dx. My theory: the drs were trying to prove this
was trauma related and therefore covered by my insurance company. The
neuro involved is a well-known patient advocate but who unfortunately
doesn't consider all possibilites of etiology if they won't have
coverage from an auto wreck, slip/fall, work comp claim, etc.
(Sorry, I definitely vented there a bit, huh?)
D: based on positive ANA, family hx (has sibling who has Lupus),
previous seizure disorder (alleged to be caused by trauma, but suspect
etiology confirmed just because it was an easy answer) She did have
facial rash, eye pain, etc. after the onset of TM.
E: I remember the ANA, but it was on the low, high side. Possible
steroid treatment affected this result.
F: Can't answer this one. TM diagnosed first, Lupus DX was treated as
"non-significant" No follow-up testing of ANA except about a month
after initial and both results were very close in range. Again,
affected by treatment w/steroids?
G: All other testing is negative, Lyme disease, syphillis (spelling?) ,
HIV, etc. No other indication of any other underlying condition other
than 7 year history of petite mal seizures with 1 grand mal episode
documented. Was on dilantin (known offender of drug-induced lupus).
Was non-compliant with dilantin level testing, changed doses just
because she thought she knew best.
H: First thought was "in the buttocks", but the rest of your questions
clarified what you were wanting!!!! Did have site reaction, but nothing
abnormal. Was given by her employer-SNF.
We understand a report was filed with CDC? or whoever controls
such things. No indication of complaints of other possible
contamination noted.
I: Had flue shot approximately 1 year prior with no adverse reaction
noted. Unknown about previous tetnaus injection, but based on her age,
assume she has had some (haven't gotten to question her about this yet.
It is on my list of questions, too.)
J: Not happening yet. Has had good response to PT for the upper
extremities, but is basically a high level quad. Symptoms in the upper
extremities seems to wax/wane.
K: Lots of allegations. Research on the Net "Med Acess" professly
denies that tetnaus toxoid injections can cause TM. However, it
therefore becomes apparent it has been alleged. Our research has
indicated several cases (mostly outside the U.S.) that have noted a
similar reaction to Tetnaus; however, it involved the peripheral nervous
system, not CNS.
L: She was tested via tetnaus titer, approximately 5 months after onset
of TM and the Tetnaus injection: was in the high/normal range.
Appeared not to be unexpected based upon the injection being
administered such a short time ago.
M: See "K"
N: Yes!!!!!!! Our research through the Arthritis Foundation has
indicated that it is a likely, although not "normal" complication of
Lupus.
O: Unknown. Our thoughts are much like your initial reaction, with a
compromised immune system, anything could happen.
P: Again, unknown. Good question.
This is a workers' compensation claim that I am handling. The tetnaus
shot was given due to an on-the-job injury. As noted above the initial
allegation was made that this was caused by trauma although MRI and CT
scans of the cervical/thoracic spine indicated increased signal from C-3
to T-2. That would be some trauma, huh?
I am really convinced that this is not due to the tetnaus and therefore
my company should not accept the claim. However, whether we end up
accepting it or not, the fact remains that this patient is NOT BEING
TREATED IN ANY WAY FOR LUPUS. She has been treated with rehab, etc., as
a spinal-cord injury, not as a disease process. I think she has not had
the proper treatment, but at this point, we have not accepted the case
and can't control the medical provided.
Currently, she has experienced pnuemonia 2 weeks ago and again is
hospitalized for high fevers, eye pain, low blood pressure, lower lobe
infiltrates, etc. A new cycle of Lupus? I don't know. We are trying
to get her examined by a rhumatologist, but have had to cancel due the
complications of pnuemonia, etc as it will involve 4 hours travel to the
specialist.
Anything you can think of will help. You're right it is a medical
mystery and has been a great case to work as I have learned a lot
working with the Case Manager. She's a great RN, CM, and a good friend,
too.
Will anxiously await your reply when you think all this through.
Ms Creed; I for one hope you endup paying. Then maybe some actuary will
find it deneficial to through a little money towards resurch as to the
cause of tm and for me that would be a GOOD THING. The $135,000 payed
out by my private insurance company may have been avoided by a two
dollar preventive!! DCJones