Neuromyelitis Optica as a Paraneoplastic Manifestation of Bronchogenic Carcinoma: A Case Report

Abstract

Context: Neuromyelitis optica spectrum disorders (NMOSDs) are an autoimmune disorders resulting from astrocytic aquaporin-4 (AQP-4) channelopathy in young adults. The AQP-4 IgG antibodies may be present in the context of some paraneoplastic disorders which should be suspected when NMOSD occur in elderly patients. Findings: This study reported a case of 65-year-old male patient with paraneoplastic NMOSD. The patient presented with quadriparesis due to acute cervical long segment myelitis not responsive to pulse steroid therapy; 18 months later he developed acute bilateral diminution of visual acuity due to bilateral optic neuritis with no response to either pulse steroid therapy or IVIG. Serological serum tests revealed that the patient was AQP-4-IgG positive, but after 22 months of the initial presentation, the patient showed widespread metastasis in bone and liver secondary to bronchogenic carcinoma. Conclusion: Late onset of NMOSD should raise the suspicion of paraneoplastic neurological disorder, and extensive work up is advised to identify the underlying neoplasm.

Paraneoplastic seropositive AQP4-IgG neuromyelitis optica spectrum disorder associated with sigmoid adenocarcinoma

“…However there have also been reports of paraneoplastic NMOSD in cancers originating from the thymus, thyroid, ovaries, prostate and oesophagus, and in our case, the sigmoid. [7][8][9][10] We report a case of transverse myelitis as the presenting syndrome of NMOSD in association with sigmoid adenocarcinoma. Even though our patient had serum AQP4 positive, given that sigmoid adenocarcinoma is a relatively common cancer occurring in people older than 50 years, testing tumour tissue for AQP4 would have solidified our possibility of our patient's NMOSD as being a truly paraneoplastic phenomenon.…”

Paraneoplastic Neuromyelitis Optica Spectrum Disorder Associated With Lung Adenocarcinoma: A Case Report

“…Neuromyelitis Optica spectrum disorder (NMOSD) can manifest in the context of systemic autoimmune diseases, such as Systemic Lupus Erythematosus and Sjogren syndrome ( 6 ). As part of immune dysregulation, some cases of NMOSD are reported as a paraneoplastic manifestation ( 7 – 11 ). Herein, we discuss a case of a 76-year-old woman with NMOSD associated with metastatic lung adenocarcinoma.…”