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Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report

Neuromyelitis optica, an autoimmune inflammatory disorder affecting the central nervous system, can occur in a paraneoplastic context, although rare. We report an intriguing case of a 71-year-old woman with a history of triple-negative infiltrating ductal breast carcinoma, manifesting with paraneopl...

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Autores principales: Srichawla, Bahadar S, Sivakumar, Shravan, Cheraghi, Seyedeh N, Kipkorir, Vincent, Garcia-Dominguez, Maria A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10475258/
https://www.ncbi.nlm.nih.gov/pubmed/37667745
http://dx.doi.org/10.1177/2050313X231198322
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author Srichawla, Bahadar S
Sivakumar, Shravan
Cheraghi, Seyedeh N
Kipkorir, Vincent
Garcia-Dominguez, Maria A
author_facet Srichawla, Bahadar S
Sivakumar, Shravan
Cheraghi, Seyedeh N
Kipkorir, Vincent
Garcia-Dominguez, Maria A
author_sort Srichawla, Bahadar S
collection PubMed
description Neuromyelitis optica, an autoimmune inflammatory disorder affecting the central nervous system, can occur in a paraneoplastic context, although rare. We report an intriguing case of a 71-year-old woman with a history of triple-negative infiltrating ductal breast carcinoma, manifesting with paraneoplastic neuromyelitis optica that led to significant respiratory failure and required a cervical laminectomy. The patient presented with pain in the left breast, weakness in the lower extremities, and neck pain. The neurological evaluation showed 2/5 muscle strength in all extremities, diffuse hyperreflexia, and loss of multimodal sensation below the shoulder. She developed acute respiratory failure that required mechanical ventilation. Magnetic resonance imaging highlighted a diffuse abnormal increase in T2 signal intensity throughout the posterior and central portion of the cervical and thoracic spinal cord consistent with longitudinally extensive transverse myelitis, and significant cervical cord compression at C3–C4. Magnetic resonance imaging of the brain showed non-enhancing T2/fluid-attenuated inversion recovery (FLAIR) white matter hyperintensities and cerebellar hemispheres. The serum cell-based assay study demonstrated a high anti-aquaporin-4 immunoglobulin G titer (>1:160) confirming the diagnosis of neuromyelitis optica. She was taken for bilateral laminectomy from C3 to C6. Despite intravenous methylprednisolone and plasmapheresis treatment, no significant recovery was achieved, necessitating tracheostomy and percutaneous endoscopic gastrostomy. Subsequent rituximab treatment led to a mild improvement, with no new lesions on repeat magnetic resonance imaging. This case raises suspicion of the potential for neuromyelitis optica to occur as a paraneoplastic phenomenon, strengthening the need for vigilance in patients with malignancies.
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spelling pubmed-104752582023-09-04 Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report Srichawla, Bahadar S Sivakumar, Shravan Cheraghi, Seyedeh N Kipkorir, Vincent Garcia-Dominguez, Maria A SAGE Open Med Case Rep JCMS Case Report Neuromyelitis optica, an autoimmune inflammatory disorder affecting the central nervous system, can occur in a paraneoplastic context, although rare. We report an intriguing case of a 71-year-old woman with a history of triple-negative infiltrating ductal breast carcinoma, manifesting with paraneoplastic neuromyelitis optica that led to significant respiratory failure and required a cervical laminectomy. The patient presented with pain in the left breast, weakness in the lower extremities, and neck pain. The neurological evaluation showed 2/5 muscle strength in all extremities, diffuse hyperreflexia, and loss of multimodal sensation below the shoulder. She developed acute respiratory failure that required mechanical ventilation. Magnetic resonance imaging highlighted a diffuse abnormal increase in T2 signal intensity throughout the posterior and central portion of the cervical and thoracic spinal cord consistent with longitudinally extensive transverse myelitis, and significant cervical cord compression at C3–C4. Magnetic resonance imaging of the brain showed non-enhancing T2/fluid-attenuated inversion recovery (FLAIR) white matter hyperintensities and cerebellar hemispheres. The serum cell-based assay study demonstrated a high anti-aquaporin-4 immunoglobulin G titer (>1:160) confirming the diagnosis of neuromyelitis optica. She was taken for bilateral laminectomy from C3 to C6. Despite intravenous methylprednisolone and plasmapheresis treatment, no significant recovery was achieved, necessitating tracheostomy and percutaneous endoscopic gastrostomy. Subsequent rituximab treatment led to a mild improvement, with no new lesions on repeat magnetic resonance imaging. This case raises suspicion of the potential for neuromyelitis optica to occur as a paraneoplastic phenomenon, strengthening the need for vigilance in patients with malignancies. SAGE Publications 2023-09-01 /pmc/articles/PMC10475258/ /pubmed/37667745 http://dx.doi.org/10.1177/2050313X231198322 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle JCMS Case Report
Srichawla, Bahadar S
Sivakumar, Shravan
Cheraghi, Seyedeh N
Kipkorir, Vincent
Garcia-Dominguez, Maria A
Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title_full Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title_fullStr Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title_full_unstemmed Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title_short Breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: A case report
title_sort breast cancer-associated paraneoplastic neuromyelitis optica with cervical cord compression and spondylosis requiring laminectomy: a case report
topic JCMS Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10475258/
https://www.ncbi.nlm.nih.gov/pubmed/37667745
http://dx.doi.org/10.1177/2050313X231198322
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