Abstract
Background: Serum autoantibody against the astrocytic water channel aquaporin 4 (AQP4-IgG) is a biomarker for neuromyelitis optica spectrum disorder (NMOSD). In some patients the presence of AQP4-IgG reflects a tumor-driven immune response.
Methods: AQP4-IgG was measured with a recombinant immunofluorescence assay1. Clinical data and MRI were reviewed.
Case: A 64-year old man developed sudden loss of vision and reduced visual field in both eyes. Visual acuity was 1/36 and 6/24 in the right and left eye, respectively. The optic disc was swollen, mostly in the right eye and bilateral optic neuritis (ON) was diagnosed by an ophthalmologist. Brain MRI and cerebrospinal fluid (CSF) intracranial pressure were normal. CSF showed 4 leukocytes, oligoclonal bands and normal IgG index and protein level. At follow-up after three month atrophy and visual loss (2/36) of the right eye was apparent.
Two years earlier than ON the patient had been treated for thyroid cancer, by thyroidectomy and radioactive iodine. Five years later he was diagnosed with disseminated colon cancer. Further three years later he was still positive for AQP4-IgG, had no relapse of NMOSD and died due to his cancer.
Conclusions: This case suggests that AQP4 autoimmunity may in some cases have a paraneoplastic basis.
1. Asgari N, Nielsen C, Stenager E, Kyvik KO, Lillevang ST. HLA, PTPN22 and PD-1 associations as markers of autoimmunity in neuromyelitis optica. Multiple Sclerosis. 2012;18(1):23-30.
Methods: AQP4-IgG was measured with a recombinant immunofluorescence assay1. Clinical data and MRI were reviewed.
Case: A 64-year old man developed sudden loss of vision and reduced visual field in both eyes. Visual acuity was 1/36 and 6/24 in the right and left eye, respectively. The optic disc was swollen, mostly in the right eye and bilateral optic neuritis (ON) was diagnosed by an ophthalmologist. Brain MRI and cerebrospinal fluid (CSF) intracranial pressure were normal. CSF showed 4 leukocytes, oligoclonal bands and normal IgG index and protein level. At follow-up after three month atrophy and visual loss (2/36) of the right eye was apparent.
Two years earlier than ON the patient had been treated for thyroid cancer, by thyroidectomy and radioactive iodine. Five years later he was diagnosed with disseminated colon cancer. Further three years later he was still positive for AQP4-IgG, had no relapse of NMOSD and died due to his cancer.
Conclusions: This case suggests that AQP4 autoimmunity may in some cases have a paraneoplastic basis.
1. Asgari N, Nielsen C, Stenager E, Kyvik KO, Lillevang ST. HLA, PTPN22 and PD-1 associations as markers of autoimmunity in neuromyelitis optica. Multiple Sclerosis. 2012;18(1):23-30.
| Originalsprog | Engelsk |
|---|---|
| Publikationsdato | mar. 2015 |
| Antal sider | 1 |
| Status | Udgivet - mar. 2015 |
| Begivenhed | Dansk Neurologisk Selskabs Årsmøde - Hotel Munkebjerg, Vejle, Danmark Varighed: 13. mar. 2015 → 14. mar. 2015 |
Konference
| Konference | Dansk Neurologisk Selskabs Årsmøde |
|---|---|
| Lokation | Hotel Munkebjerg |
| Land/Område | Danmark |
| By | Vejle |
| Periode | 13/03/2015 → 14/03/2015 |