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Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report

RATIONALE: An acute presentation with diffuse magnetic resonance imaging lesions can have a broad differential. Demyelination and malignancy are important considerations. Therefore, sometimes it is hard to differentiate glioma from some demyelinating diseases solely on imaging because of the similar...

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Autores principales: Liu, Yuanyuan, Gao, Feng, Hao, Hongjun, Sun, Weiping, Huang, Yining
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758164/
https://www.ncbi.nlm.nih.gov/pubmed/29390462
http://dx.doi.org/10.1097/MD.0000000000009193
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author Liu, Yuanyuan
Gao, Feng
Hao, Hongjun
Sun, Weiping
Huang, Yining
author_facet Liu, Yuanyuan
Gao, Feng
Hao, Hongjun
Sun, Weiping
Huang, Yining
author_sort Liu, Yuanyuan
collection PubMed
description RATIONALE: An acute presentation with diffuse magnetic resonance imaging lesions can have a broad differential. Demyelination and malignancy are important considerations. Therefore, sometimes it is hard to differentiate glioma from some demyelinating diseases solely on imaging because of the similar clinical presentation and imaging features. Detection of highly specific serum autoantibody marker aquaporin-4 (AQP4)-IgG positivity has helped to define a category of neuromyelitis optica spectrum disorders (NMOSD), but the test of AQP4 antibody has not been reported in patients with glioma. PATIENTS CONCERNS AND DIAGNOSES: We report a case of a 56-year-old woman with cerebrospinal fluid (CSF) positive aquaporin-4 antibodies with initial response to immune therapy and secondary deterioration. A surgical biopsy revealed an anaplastic astrocytoma. INTERVENTIONS AND OUTCOMES: After the admission the patient was treated with a short course of intravenous steroid agents. After anaplastic astrocytoma was diagnosed, she began to receive a radiation treatment and soon later experienced a clinical deterioration with frequent epilepsy seizure and disturbance of consciousness within a few months. LESSON: This case indicates that tumors could lead to polyclonal antibody responses as in this case with aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies. The absence of a typical clinical phenotype and lack of sustained response to immunotherapy should alert the clinical suspicion of an alternative diagnosis. When AQP4 antibody was detected positive in CSF of a patient but negative in serum, differential diagnosis should especially be considered.
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spelling pubmed-57581642018-01-29 Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report Liu, Yuanyuan Gao, Feng Hao, Hongjun Sun, Weiping Huang, Yining Medicine (Baltimore) 5300 RATIONALE: An acute presentation with diffuse magnetic resonance imaging lesions can have a broad differential. Demyelination and malignancy are important considerations. Therefore, sometimes it is hard to differentiate glioma from some demyelinating diseases solely on imaging because of the similar clinical presentation and imaging features. Detection of highly specific serum autoantibody marker aquaporin-4 (AQP4)-IgG positivity has helped to define a category of neuromyelitis optica spectrum disorders (NMOSD), but the test of AQP4 antibody has not been reported in patients with glioma. PATIENTS CONCERNS AND DIAGNOSES: We report a case of a 56-year-old woman with cerebrospinal fluid (CSF) positive aquaporin-4 antibodies with initial response to immune therapy and secondary deterioration. A surgical biopsy revealed an anaplastic astrocytoma. INTERVENTIONS AND OUTCOMES: After the admission the patient was treated with a short course of intravenous steroid agents. After anaplastic astrocytoma was diagnosed, she began to receive a radiation treatment and soon later experienced a clinical deterioration with frequent epilepsy seizure and disturbance of consciousness within a few months. LESSON: This case indicates that tumors could lead to polyclonal antibody responses as in this case with aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies. The absence of a typical clinical phenotype and lack of sustained response to immunotherapy should alert the clinical suspicion of an alternative diagnosis. When AQP4 antibody was detected positive in CSF of a patient but negative in serum, differential diagnosis should especially be considered. Wolters Kluwer Health 2017-12-22 /pmc/articles/PMC5758164/ /pubmed/29390462 http://dx.doi.org/10.1097/MD.0000000000009193 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 5300
Liu, Yuanyuan
Gao, Feng
Hao, Hongjun
Sun, Weiping
Huang, Yining
Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title_full Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title_fullStr Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title_full_unstemmed Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title_short Anaplastic astrocytoma with aquaporin-4 positive in CSF: A case report
title_sort anaplastic astrocytoma with aquaporin-4 positive in csf: a case report
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758164/
https://www.ncbi.nlm.nih.gov/pubmed/29390462
http://dx.doi.org/10.1097/MD.0000000000009193
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