Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature
A 45-year-old female suffering from severe thoracic pain was admitted to the emergency department of our hospital. Thorough clinical examination revealed paresis of the left lower limb and sensory deficit at the level of the Th4 vertebra. MRI of the thoracic spine demonstrated a lesion at the level...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2011/393568 |
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| author | M. E. Evangelopoulos G. Koutsis E. Andreadou C. Potagas A. Dimirakopoulos C. Sfagos |
| author_facet | M. E. Evangelopoulos G. Koutsis E. Andreadou C. Potagas A. Dimirakopoulos C. Sfagos |
| author_sort | M. E. Evangelopoulos |
| collection | DOAJ |
| description | A 45-year-old female suffering from severe thoracic pain was admitted to the emergency department of our hospital. Thorough clinical examination revealed paresis of the left lower limb and sensory deficit at the level of the Th4 vertebra. MRI of the thoracic spine demonstrated a lesion at the level of Th1–Th7. Despite initial improvement following i.v. corticosteroid administration, the patient's clinical status deteriorated, with recurrence of myelitis and extension of the lesion to Th12. She developed paraparesis, hyperreflexia and spasticity of both legs, symmetrical sensory deficit below Th4, and sphincter dysfunction. Differential diagnosis included infectious, metabolic, neoplastic/paraneoplastic, and ischemic causes as well as multiple sclerosis. NMO IgG was found positive and led to the diagnosis of longitudinal extensive transverse myelitis (LETM) in the NMO spectrum disorders. Administration of immunosuppressive therapy resulted in gradual improvement of the patient's clinical status and stabilization for five years. In the setting of LETM, patients with antiaquaporin 4 IgGs can present features of coexisting systemic involvement. A thorough differential diagnosis is required to guide appropriate therapy. |
| format | Article |
| id | doaj-art-807b79ee4bbc4fb680f6f240027704b9 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-807b79ee4bbc4fb680f6f240027704b92025-02-03T06:14:11ZengWileyCase Reports in Medicine1687-96271687-96352011-01-01201110.1155/2011/393568393568Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the LiteratureM. E. Evangelopoulos0G. Koutsis1E. Andreadou2C. Potagas3A. Dimirakopoulos4C. Sfagos5Department of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceDepartment of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceDepartment of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceDepartment of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceDepartment of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceDepartment of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, GreeceA 45-year-old female suffering from severe thoracic pain was admitted to the emergency department of our hospital. Thorough clinical examination revealed paresis of the left lower limb and sensory deficit at the level of the Th4 vertebra. MRI of the thoracic spine demonstrated a lesion at the level of Th1–Th7. Despite initial improvement following i.v. corticosteroid administration, the patient's clinical status deteriorated, with recurrence of myelitis and extension of the lesion to Th12. She developed paraparesis, hyperreflexia and spasticity of both legs, symmetrical sensory deficit below Th4, and sphincter dysfunction. Differential diagnosis included infectious, metabolic, neoplastic/paraneoplastic, and ischemic causes as well as multiple sclerosis. NMO IgG was found positive and led to the diagnosis of longitudinal extensive transverse myelitis (LETM) in the NMO spectrum disorders. Administration of immunosuppressive therapy resulted in gradual improvement of the patient's clinical status and stabilization for five years. In the setting of LETM, patients with antiaquaporin 4 IgGs can present features of coexisting systemic involvement. A thorough differential diagnosis is required to guide appropriate therapy.http://dx.doi.org/10.1155/2011/393568 |
| spellingShingle | M. E. Evangelopoulos G. Koutsis E. Andreadou C. Potagas A. Dimirakopoulos C. Sfagos Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature Case Reports in Medicine |
| title | Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature |
| title_full | Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature |
| title_fullStr | Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature |
| title_full_unstemmed | Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature |
| title_short | Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature |
| title_sort | neuromyelitis optica spectrum disease with positive autoimmune indices a case report and review of the literature |
| url | http://dx.doi.org/10.1155/2011/393568 |
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