Neuromyelitis optica spectrum disorder in a patient with systemic lupus erythematosus and anti-phospholipid antibody syndrome

Abstract

Neuromyelitis optica (NMO) is a demyelinating disease of the central nervous system characterized by severe episodes of optic nerve and spinal cord inflammation. NMO-IgG (anti-aquaporin-4) has been recently described as a sensitive and specific marker for NMO. As there have been prior published reports of an association between NMO and systemic autoimmune diseases, the prognostic value of the antibody test in these cases is uncertain. We describe a 47-year old woman with recurrent transverse myelitis and a long-standing history of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS). While she did not have a history of optic neuritis, serological testing for the NMO-IgG was positive when she was admitted for her second episode of transverse myelitis. Testing for the NMO-IgG in cases of isolated or recurrent transverse myelitis attributed to current SLE and APLS may help clarify the diagnosis of a distinct disease process likely to cause recurrent and severe disability, warranting more aggressive immunotherapy. Multiple Sclerosis 2008; 14: 425—427. http://msj.sagepub.com

Keywords

anti-phospholpid antibody syndrome neuromyelitis optica NMO-IgG systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Wingerchuk DM , Lennon VA , Pittock SJ , Lucchinetti CF , Weinshenker BG Revised diagnostic criteria for neuromyelitis optica. Neurology 2006; 66: 1485-89.

Lennon VA , Wingerchuk DM , Kryzer TJ , Pittock SJ , Lucchinetti CF , Fujihara K. et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 2004; 364: 2106-12.

Cree BA , Lamb S. , Morgan K. , Chen A. , Waubant E. , Genain C. An open label study of the effects of rituximab in neuromyelitis optica . Neurology 2005; 64: 1270-72.

Kinney EL , Berdoff RL , Rao NS , Fox LM Devic's syndrome and systemic lupus erythematosus: a case report with necropsy . Arch Neurol 1979; 36: 643-44.

Gibbs AN , Moroney J. , Foley-Nolan D. , O'Connell PG Neuromyelitis optica (devic's syndrome) in systemic lupus erythematosus: a case report. Rheumatology (Oxford) 2002; 41: 470-71.

April RS , Vansonnenberg E. A case of neuromyelitis optica (devic's syndrome) in systemic lupus erythematosus. Clinicopathologic report and review of the literature. Neurology 1976; 26: 1066-70.

Birnbaum J. , Kerr D. Devic's syndrome in a woman with systemic lupus erythematosus: diagnostic and therapeutic implications of testing for the neuromyelitis optica IgG autoantibody . Arthritis Rheum 2007; 57: 347-51.

Chan AY , Liu DT Devic's syndrome in systemic lupus erythematosus and probable antiphospholipid syndrome. Rheumatology (Oxford) 2006; 45: 120-21 (author reply 121).

Ferreira S. , Marques P. , Carneiro E. , D'Cruz D. , Gama G. Devic's syndrome in systemic lupus erythematosus and probable antiphospholipid syndrome. Rheumatology (Oxford) 2005; 44: 693-95.

10.

Wingerchuk DM , Hogancamp WF , O'Brien PC , Weinshenker BG The clinical course of neuromyelitis optica (devic's syndrome). Neurology 1999; 53: 1107-14.

11.

Nielsen S. , Nagelhus EA , Amiry-Moghaddam M. , Bourque C. , Agre P. , Ottersen OP Specialized membrane domains for water transport in glial cells: high-resolution immunogold cytochemistry of aquaporin-4 in rat brain. J Neurosci 1997; 17: 171-80.

12.

Lennon VA , Kryzer TJ , Pittock SJ , Verkman AS , Hinson SR IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med 2005; 202: 473-77.

13.

Jarius S. , Franciotta D. , Bergamaschi R. , Wright H. , Littleton E. , Palace J. et al. NMO-IgG in the diagnosis of neuromyelitis optica. Neurology 2007; 68: 1076-77.

14.

Weinshenker BG Neuromyelitis optica is distinct from multiple sclerosis. Arch Neurol 2007; 64: 899-901.

15.

Weinshenker BG , Wingerchuk DM , Vukusic S. , Linbo L. , Pittock SJ , Lucchinetti CF et al. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis . Ann Neurol 2006; 59: 566-69.

16.

Weinshenker B. , De Seze J. , Vemersch P. , Pittock S. , Lennon V. The relationship between neuromyelitis optica and systemic autoimmune disease (S52.003), American Academy of Neurology, 2006.