Neuromyelitis Optica spectrum disorder and systemic lupus erythematosus
Keywords:
Systemic lupus erythematosus, transverse myelitis, aquaporin four antibodies, neuromyelitis optica spectrum disorderAbstract
Neuromyelitis Optica spectrum disorder (NMOSD) is a rare autoimmune–mediated demyelinating inflammatory disease that effects the central nervous system. The characteristic symptoms of NMOSD are optic neuritis or acute transverse myelitis. Anti-aquaporin 4 antibody is a specific serological marker for this disease. NMOSD has been reported as either a manifestation of SLE or as a coexisting condition of other autoimmune diseases. This report discussed a case of a 34-year-old female patient who initially presented with a right-sided weakness for two months. She had progressed to quadriparesis and bladder dysfunction within a few days. She had positive autoimmune serology tests indicating for SLE with a history of nephrotic syndrome. In addition, she had AQP-4 antibodies in CSF and the MRI cervical spine showed longitudinally extensive transverse myelitis. The evidences indicated that she has NMOSD with SLE. A prompt diagnosis and treatments are essential to decrease morbidity and mortality. There are a few literatures regarding NMOSD with coexisting SLE, and more information is needed to understand. A high index of suspicion of this rare disease is required to avoid delayed diagnosis and treatment.
References
Katsumata Y, Kawachi I, Kawaguchi Y, Gono T, Ichida H, Hara M, et al. Semiquantitative measurement of aquaporin-4 antibodies as a possible surrogate marker of neuromyelitis optica spectrum disorders with systemic autoimmune diseases. Modern rheumatology. 2012;22(5):676-84.
Pittock SJ, Lennon VA, de Seze J, Vermersch P, Homburger HA, Wingerchuk DM, et al. Neuromyelitis Optica and Non–Organ-Specific Autoimmunity. Archives of Neurology. 2008;65(1):78-83.
Yaregal S, Bekele N, Gebrewold Y, Tadesse A. Neuromyelitis Optica Spectrum Disorder: A Case Report. International medical case reports journal. 2021;14:643-8.
Ota Y, Srinivasan A, Capizzano AA, Bapuraj JR, Kim J, Kurokawa R, et al. Central Nervous System Systemic Lupus Erythematosus: Pathophysiologic, Clinical, and Imaging Features. Radiographics : a review publication of the Radiological Society of North America, Inc. 2022;42(1):212-32.
Cruz RA, Chaudhary S, Guevara M, Meltzer E. Neuromyelitis Optica Spectrum Disorders (NMOSD) and Connective Tissue Disease (CTD): an Update for the Rheumatologist. Current rheumatology reports. 2021;23(6):33.
Shidahara K, Hayashi K, Sada KE, Hiramatsu S, Morishita M, Watanabe H, et al. Refractory neuromyelitis optica spectrum disorder in systemic lupus erythematosus successfully treated with rituximab. Lupus. 2018;27(8):1374-7.
Mehta P, Gupta L, Muhammed H, Misra DP, Lawrence A, Agarwal V, et al. Spectrum of Myelitis in Systemic Lupus Erythematosus: Experience from a Single Tertiary Care Centre over 25 Years. Mediterranean journal of rheumatology. 2021;32(1):31-8.
Jacobi C, Stingele K, Kretz R, Hartmann M, Storch-Hagenlocher B, Breitbart A, et al. Neuromyelitis optica (Devic's syndrome) as first manifestation of systemic lupus erythematosus. Lupus. 2006;15(2):107-9.
Karim S, Majithia V. Devic’s Syndrome as Initial Presentation of Systemic Lupus Erythematosus. The American Journal of the Medical Sciences. 2009;338(3):245-7.
Jarius S, Jacobi C, de Seze J, Zephir H, Paul F, Franciotta D, et al. Frequency and syndrome specificity of antibodies to aquaporin-4 in neurological patients with rheumatic disorders. Multiple Sclerosis Journal. 2011;17(9):1067-73.
Polgár A, Rózsa C, Müller V, Matolcsi J, Poór G, Kiss EV. Devic's syndrome and SLE: Challenges in diagnosis and therapeutic possibilities based on two overlapping cases. Autoimmunity Reviews. 2011;10(3):171-4.
Magro Checa C, Cohen D, Bollen ELEM, van Buchem MA, Huizinga TWJ, Steup-Beekman GM.Demyelinating disease in SLE: Is it multiple sclerosis or lupus? Best Practice & Research Clinical Rheumatology. 2013;27(3):405-24.
Závada J, Nytrová P, Wandinger KP, Jarius S, Svobodová R, Probst C, et al. Seroprevalence and specificity of NMO-IgG (anti-aquaporin 4 antibodies) in patients with neuropsychiatric systemic lupus erythematosus. Rheumatology international. 2013;33(1):259-63.
Adawi M, Bisharat B, Bowirrat A. Systemic Lupus Erythematosus (SLE) Complicated by Neuromyelitis Optica (NMO – Devic's Disease): Clinic-Pathological Report and Review of the Literature. Clinical Medicine Insights: Case Reports. 2014;7:CCRep.S15177.
Asgari N, Jarius S, Laustrup H, Skejoe HPB, Lillevang ST, Weinshenker BG, et al. Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study. Multiple Sclerosis Journal. 2017;24(3):331-9.
Sanna G, Bertolaccini LM, Khamashta AM. Neuropsychiatric Involvement in Systemic Lupus Erythematosus:Current Therapeutic Approach. Current Pharmaceutical Design. 2008;14(13):1261-9.
Greenberg BM. The Neurologic Manifestations of Systemic Lupus Erythematosus. The Neurologist. 2009;15(3).
Chessa E, Piga M, Floris A, Mathieu A, Cauli A. Demyelinating syndrome in SLE: review of different disease subtypes and report of a case series. Reumatismo. 2017;69(4):175-83.
Li X-Y, Xiao H-B, Pai P. Myelitis in systemic lupus erythematosus. Journal of Clinical Neuroscience. 2017;44:18-22.
Mok CC, Lau CS, Wong RW. Neuropsychiatric manifestations and their clinical associations in southern Chinese patients with systemic lupus erythematosus. The Journal of Rheumatology. 2001;28(4):766.
Piga M, Chessa E, Peltz MT, Floris A, Mathieu A, Cauli A. Demyelinating syndrome in SLE encompasses different subtypes: Do we need new classification criteria? Pooled results from systematic literature review and monocentric cohort analysis. Autoimmunity Reviews. 2017;16(3):244-52.
Mehmood T, Munir I, Abduraimova M, Ramirez MA, Paghdal S, McFarlane IM. Longitudinally Extensive Transverse Myelitis Associated With Systemic Lupus Erythematosus: A Case Report and Literature Review. American journal of medical case reports. 2019;7(10):244-9.
Williams JN, Speyer CB, Kreps DJ, Kimbrough DJ, Costenbader K, Bhattacharyya S. Spinal cord syndromes in patients with systemic lupus erythematosus: differentiating lupus myelitis, neuromyelitis optica, and multiple sclerosis. Lupus. 2019;28(14):1656-62.
Lin L, Hang H, Zhang J, Lu J, Chen D, Shi J. Clinical significance of anti-SSA/Ro antibody in Neuromyelitis optica spectrum disorders. Multiple Sclerosis and Related Disorders. 2022;58:103494.
Pirro F, Mantero V, Rigamonti A, Scaccabarozzi C, Pozzetti U, Balgera R, et al. A case of longitudinally extensive transverse myelitis in an 80-year-old patient with systemic lupus erythematous and anti-aquaporin 4 antibodies. Multiple Sclerosis and Related Disorders. 2021;51:102899.
Zhang S, Wang Z, Zhao J, Wu Di, Li J, Wang Q, et al. Clinical features of transverse myelitis associated with systemic lupus erythematosus. Lupus. 2020;29(4):389-97.
Nasir S, Kerr DA, Birnbaum J. Nineteen episodes of recurrent myelitis in a woman with neuromyelitis optica and systemic lupus erythematosus. Arch Neurol. 2009;66(9):1160-3.
Chessa E, Piga M, Floris A, Mathieu A, Cauli A. Severe neuropsychiatric systemic lupus erythematosus successfully treated with rituximab: an alternative to standard of care. Open access rheumatology : research and reviews. 2017;9:167-70.
Furtado I, Pinheiro G, Campar A, Mendonça T. Association of severe and therapy-refractory systemic lupus erythematosus and neuromyelitis optica: a management challenge. BMJ Case Reports. 2018;2018:bcr-2017-222139.
Martín-Nares E, Hernandez-Molina G, Fragoso-Loyo H. Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder and systemic autoimmune diseases overlap syndrome: a single-center experience. Lupus. 2019;28(11):1302-11.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Thai Journal Citation Index Centre
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Journal of TCI is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence, unless otherwise stated. Please read our Policies page for more information.
