During Prednisone Taper, the Patient Presented with Sensory Loss in Both Legs.

Neurological examination demonstrated a D7 sensory level. Spinal MRI revealed an inflammatory longitudinal myelitis lesion extending from D7 to D11, here shown on sagittal T2 of the dorsal spine (A). The patient was treated with induction therapy followed by monthly pulsed i.v. cyclophosphamide infusions. After the 5th infusion, the patient developed para-paresis, urinary incontinence, and sensory level above her legs. A spinal MRI demonstrated a new longitudinal lesion extending D6–D9 (B). Neuro-ophthalmologic studies were negative. Anti-aquaporin 4 antibodies (AQP4) were negative at that time. Induction therapy was re-instituted; maintenance with azathioprine and high-dose IVIg was initiated. The patient’s condition stabilized, and she remained with minimal left-hand paresis and mild spinal ataxia and sensory loss, with improvement visible on repeat MRI (C).