Abstract
Longitudinally extensive transverse myelitis (LETM) is a condition shown to confer
high risk of conversion into neuromyelitis optica (NMO). Increasing evidence from
immunological and histopathological studies suggests that LETM is an autoimmune disorder
caused by pathogenic antibodies to aquaporin-4 (AQP4-Ab), the most abundant water
channel in the CNS, at least in a subset of patients. However, cases of infectious
or parainfectious NMO/LETM (mostly associated with herpes zoster) have been repeatedly
reported in the previous literature, raising the question of aetiological diversity
in NMO/LETM. Here we present a case of acute LETM in a 63-year-old patient occurring
two weeks after reactivation of varicella zoster virus (VZV). Serological testing
revealed antibodies to AQP4. Plasma exchange was paralleled by disappearance of AQP4-Ab
and sustained clinical improvement. Our observations provide further evidence for
a pathogenic role of AQP4-Ab in LETM and suggest that AQP4-Ab associated auto-immunity
should be considered also in apparently infectious/parainfectious settings.
Keywords
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Article info
Publication history
Accepted:
August 15,
2008
Received in revised form:
August 13,
2008
Received:
May 26,
2008
Identification
Copyright
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
