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New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report.

Komolafe MA, Komolafe EO, Sunmonu TA, Olateju SO, Asaleye CM, Adesina OA, Badmus SA - J Med Case Rep (2008)

Bottom Line: She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome.We also highlight the unusual association with antiphospholipid syndrome.Physicians should screen such patients for autoimmune disorders.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. adeyoyin2001@yahoo.com.

ABSTRACT

Introduction: Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.

Case presentation: We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.

Conclusion: Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.

No MeSH data available.


Related in: MedlinePlus

Cervical spine magnetic resonance imaging showing the hyperintense focus (Arrow A).
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Figure 1: Cervical spine magnetic resonance imaging showing the hyperintense focus (Arrow A).

Mentions: The cranial MRI showed normal T1 and T2 weighted images. The initial cervical T2 weighted MRI showed patchy ill-defined central linear hyperintense focus in the intramedullary portion of the spinal cord between C1 and C5 in keeping with transverse myelitis (Figure 1). Her erythrocyte sedimentation rate (ESR) on admission was 67 mm/hour and she had positive lupus erythematosus (LE) cells. Antinuclear and anti double-stranded antibodies were negative. Cardiolipin IgM was 15.0 MPL/ml (reference range 0.00–3.5 MPL/ml) while Cardiolipin IgG was within normal limits at 2.8 mGPL/ml (reference range 0.00–15.0 GPL/ml). Her prothrombin time (PT) was prolonged -PT 18.4s, control 12.9s, prothrombin time ratio (PTR) 1.4, international normalized ratio (INR) 1.6.


New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report.

Komolafe MA, Komolafe EO, Sunmonu TA, Olateju SO, Asaleye CM, Adesina OA, Badmus SA - J Med Case Rep (2008)

Cervical spine magnetic resonance imaging showing the hyperintense focus (Arrow A).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600793&req=5

Figure 1: Cervical spine magnetic resonance imaging showing the hyperintense focus (Arrow A).
Mentions: The cranial MRI showed normal T1 and T2 weighted images. The initial cervical T2 weighted MRI showed patchy ill-defined central linear hyperintense focus in the intramedullary portion of the spinal cord between C1 and C5 in keeping with transverse myelitis (Figure 1). Her erythrocyte sedimentation rate (ESR) on admission was 67 mm/hour and she had positive lupus erythematosus (LE) cells. Antinuclear and anti double-stranded antibodies were negative. Cardiolipin IgM was 15.0 MPL/ml (reference range 0.00–3.5 MPL/ml) while Cardiolipin IgG was within normal limits at 2.8 mGPL/ml (reference range 0.00–15.0 GPL/ml). Her prothrombin time (PT) was prolonged -PT 18.4s, control 12.9s, prothrombin time ratio (PTR) 1.4, international normalized ratio (INR) 1.6.

Bottom Line: She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome.We also highlight the unusual association with antiphospholipid syndrome.Physicians should screen such patients for autoimmune disorders.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. adeyoyin2001@yahoo.com.

ABSTRACT

Introduction: Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.

Case presentation: We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.

Conclusion: Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.

No MeSH data available.


Related in: MedlinePlus