Case Reports in Medicine Volume 2011 (2011), Article ID 393568, 4 pages doi:10.1155/2011/393568
Neuromyelitis Optica Spectrum Disease with Positive Autoimmune Indices: A Case Report and Review of the Literature
Department of Neurology, Eginition Hospital, University of Athens, 74 Vas. Sophias Avenue, 11528 Athens, Greece
Received 3 June 2011; Revised 23 August 2011; Accepted 4 September 2011
Academic Editor: Marie-C?cile Nassogne
Copyright ? 2011 M. E. Evangelopoulos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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.
Continued at source.