The observations of neuromyelitis optica spectrum disorders (NMOSD) occurring in the setting of cancer suggest that aquaporin-4 (AQP4) autoimmunity may in some cases be paraneoplastic.
Results:
We describe a 72-year-old patient who developed a longitudinally extensive transverse myelitis associated with AQP4 autoantibodies in the setting of a lung adenocarcinoma recurrence. AQP4 expression was demonstrated in tumor cells. IgG in patient’s cerebrospinal fluid bound to tumor cells co-localizing with AQP4 immunoreactivity.
Conclusions and relevance:
This case expands the spectrum of paraneoplastic AQP4 autoimmunity highlighting the importance of considering an oncological screening in patients with late-onset NMOSD.
IorioRPittockSJ. Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies. Clin Exp Neuroimmunol2014; 5(2): 175–187.
3.
JiaoYFryerJPLennonVA. Updated estimate of AQP4-IgG serostatus and disability outcome in neuromyelitis optica. Neurology2013; 81(14): 1197–1204.
4.
IorioRLucchinettiCFLennonVA. Syndrome of inappropriate antidiuresis may herald or accompany neuromyelitis optica. Neurology2011; 77: 1644–1646.
5.
IorioRLucchinettiCFLennonVA. Intractable nausea and vomiting from autoantibodies against a brain water channel. Clin Gastroenterol Hepatol2013; 11(3): 240–245.
6.
IorioRDamatoVMirabellaM. Distinctive clinical and neuroimaging characteristics of longitudinally extensive transverse myelitis associated with aquaporin-4 autoantibodies. J Neurol2013; 260(9): 2396–2402.
7.
IorioRFryerJPHinsonSR. Astrocytic autoantibody of neuromyelitis optica (NMO-IgG) binds to aquaporin-4 extracellular loops, monomers, tetramers and high order arrays. J Autoimmun2013; 40: 21–27.
8.
PittockSJLennonVA. Aquaporin-4 autoantibodies in a paraneoplastic context. Arch Neurol2008; 65(5): 629–632.
9.
De SantisGCaniattiLDe VitoA. A possible paraneoplastic neuromyelitis optica associated with lung cancer. Neurol Sci2009; 30(5): 397–400.
