A case of neuromyelitis optica spectrum disorder with coexisting systemic lupus erythematosus

被引:7
作者
Sangani, Vikram [1 ]
Pokal, Mytri [1 ]
Balla, Mamtha [2 ,3 ]
Merugu, Ganesh Prasad [4 ]
Adapa, Sreedhar [5 ]
Naramala, Srikanth [6 ]
Konala, Venu Madhav [7 ]
机构
[1] Navicent Hlth, Quantum HC, Dept Internal Med, 777 Hemlock St, Macon, GA 31201 USA
[2] Univ Toledo, Dept Internal Med, 2801 W Bancroft St, Toledo, OH 43606 USA
[3] Promed Toledo Hosp, Toledo, OH USA
[4] Univ Toledo, Dept Family Med, Div Geriatr Med, 2801 W Bancroft St, Toledo, OH 43606 USA
[5] Adventist Med Ctr, Div Nephrol, Dept Internal Med, Hanford, CA USA
[6] Adventist Med Ctr, Div Rheumatol, Dept Internal Med, Hanford, CA USA
[7] Ashland Bellefonte Canc Ctr, Div Med Oncol, Dept Internal Med, Ashland, KY USA
来源
JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES | 2021年 / 11卷 / 04期
关键词
Neuromyelitis optica; optic neuritis; longitudinal extensive transverse myelitis; AQP-4; antibodies; SLE; DISEASE;
D O I
10.1080/20009666.2021.1915533
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Neuromyelitis Optica or Devic disease is changed to Neuromyelitis Optica spectrum disorder to include more diverse neurological and autoimmune manifestations. This is a severe relapsing autoimmune demyelinating disorder commonly affecting the optic nerve and spinal cord. It has been reported as either the first manifestation of SLE or as a coexisting condition with other autoimmune disorders commonly included but not limited to SLE and SS. We discussed a case of a 49-year-old female patient who was initially presented with a left-sided weakness that rapidly progressed to quadriparesis and bladder dysfunction within a few days. She had positive autoimmune serology tests for SLE posing a diagnostic challenge as SLE is associated with neurological manifestations. Due to a lack of definitive diagnostic criteria for SLE, presence of AQP-4 antibodies in CSF, and evidence of longitudinal extensive transverse myelitis in MRI cervical spine, we conclude that she has Neuromyelitis Optica spectrum disorder with probable SLE. It is possible that she may develop more signs and symptoms of SLE with time and will need close follow up. Timely diagnosis and prompt treatment are vital to decrease morbidity and mortality, as done in our case. The patient was started on high-dose steroids with significant improvement in her symptoms. These patients may need early treatment with plasmapheresis and long-term follow-up with immunotherapy to prevent relapse. There are few case reports in the literature, and more information is needed to understand and better diagnose NMO with coexisting SLE.
引用
收藏
页码:531 / 535
页数:5
相关论文
共 14 条
[1]   Relationship Between Neuromyelitis Optica Spectrum Disorder and Sjogren's Syndrome: Central Nervous System Extraglandular Disease or Unrelated, Co-Occurring Autoimmunity? [J].
Birnbaum, J. ;
Atri, N. M. ;
Baer, A. N. ;
Cimbro, R. ;
Montagne, J. ;
Casciola-Rosen, L. .
ARTHRITIS CARE & RESEARCH, 2017, 69 (07) :1069-1075
[2]  
D'Cruz DP, 2004, J RHEUMATOL, V31, P280
[3]  
Duan T, 2019, ACTA NEUROPATHOL COM, V7, P1
[4]   Neuromyelitis optica pathogenesis and aquaporin 4 [J].
Graber, David J. ;
Levy, Michael ;
Kerr, Douglas ;
Wade, William F. .
JOURNAL OF NEUROINFLAMMATION, 2008, 5 (1)
[5]   Detection of brain-specific autoantibodies to myelin oligodendrocyte glycoprotein, S100β and myelin basic protein in patients with Devic's neuromyelitis optica [J].
Haase, CG ;
Schmidt, S .
NEUROSCIENCE LETTERS, 2001, 307 (02) :131-133
[6]   Neuromyelitis optica (Devic's syndrome) as first manifestation of systemic lupus erythematosus [J].
Jacobi, C ;
Stingele, K ;
Kretz, R ;
Hartmann, M ;
Storch-Hagenlocher, B ;
Breitbart, A ;
Wildemann, B .
LUPUS, 2006, 15 (02) :107-109
[7]   IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel [J].
Lennon, VA ;
Kryzer, TJ ;
Pittock, SJ ;
Verkman, AS ;
Hinson, SR .
JOURNAL OF EXPERIMENTAL MEDICINE, 2005, 202 (04) :473-477
[8]   Clinical and imaging features of spinal cord type of neuro Behcet disease A case report and systematic review [J].
Liu, Hui-Miao ;
Dong, Ci ;
Zhang, Yong-Zhi ;
Tian, Ya-Yun ;
Chen, Hong-Xu ;
Zhang, Sai ;
Li, Na ;
Gu, Ping .
MEDICINE, 2017, 96 (40)
[9]  
Mealy MA, 2012, ARCH NEUROL-CHICAGO, V69, P9
[10]   Eculizumab in Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder [J].
Pittock, S. J. ;
Berthele, A. ;
Fujihara, K. ;
Kim, H. J. ;
Levy, M. ;
Palace, J. ;
Nakashima, I. ;
Terzi, M. ;
Totolyan, N. ;
Viswanathan, S. ;
Wang, K. -C. ;
Pace, A. ;
Fujita, K. P. ;
Armstrong, R. ;
Wingerchuk, D. M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2019, 381 (07) :614-625