The Association of Neuromyelitis Optica without Myelitis and Systemic Lupus Erythematosus: A Case Report
AbstractSystemic lupus erythematosus is an autoimmune disease. Neuromyelitis optica (Devic’s disease) is an inflammatory disorder belonging to the central nervous system. The typical characterizations include severe, immune-mediated demyelination, and axonal damage which mostly involve optic nerves and spinal cord, also the brain and brainstem. Anti-aquaporin- 4 antibody has been recently described as a highly specific marker for neuromyelitis optica. Neuromyelitis optica occasionally is linked with systemic autoimmune disorders, including systemic lupus erythematosus. Here, we describe a 26-year-old young woman with systemic lupus erythematosus who had bilateral optic neuritis with no evidence of myelitis or other core clinical criteria. However, aquaporin 4 antibody with high titer was detected. The patient received high-dose prednisolone, cyclophsphamid, and rituximab; but this treatment caused no change in her visual acuity. In patients with systemic lupus erythematosus who complicated by optic neuritis (with or without myelitis), the association of neuromyelitis optica should be considered.
Takahashi K. Systemic lupus erythematosus with neuromyelitis optica. J Clin Cell Immunol 2014; 5: 208.
Dall'Era M, Wofsy D. Clinical features of systemic lupus erythematosus. In: Firestein GS, Budd R, Gabriel SE, McInnes IB, O'Dell JR, Editors. Kelley and Firestein's textbook of rheumatology e-book. Philadelphia, PA: Elsevier Health Sciences; 2016. p. 1345-67.
Takahashi T, Fujihara K, Nakashima I, Misu T, Miyazawa I, Nakamura M, et al. Antiaquaporin-4 antibody is involved in the pathogenesis of NMO: A study on antibody titre. Brain 2007; 130(Pt 5): 1235-43.
Birnbaum J, Kerr D. Devic's syndrome in a woman with systemic lupus erythematosus: Diagnostic and therapeutic implications of testing for the neuromyelitis optica IgG autoantibody. Arthritis Rheum 2007; 57(2): 347-51.
Costa H, Faria O, Guimarćes J. Recurrent optical neuritis and systemic lupus erythematosus in a case of benign form of neuromyelitis optica spectrum disorder. Int J Clin Neurosci Ment Health 2016; 3(Suppl 3): S06.
Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85(2): 177-89.
Pittock SJ, Lucchinetti CF. Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: A decade later. Ann N Y Acad Sci 2016; 1366(1): 20-39.
Jarius S, Ruprecht K, Wildemann B, Kuempfel T, Ringelstein M, Geis C, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation 2012; 9: 14.
Adawi M, Bisharat B, Bowirrat A. Systemic lupus erythematosus (SLE) complicated by neuromyelitis optica (NMO-Devic's Disease):
Clinic-pathological report and review of the literature. Clin Med Insights Case Rep 2014; 7: 41-7.
Asgari N, Jarius S, Laustrup H, Skejoe HP, Lillevang ST, Weinshenker BG, et al. Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study. Mult Scler 2017; 1352458517699791.
Maritsi D, Al-Obadi M, Melo-Gomes S, Tullus K, Pilkington CA. Systemic lupus erythematosus complicated by neuromyelitis optica (Devic's Syndrome): Case series from a single paediatric rheumatology centre. Pediatr Rheumatol Online J 2011; 9(Suppl 1): P241.