Fatal anti-aquaporin-4 seropositive neuromyelitis optica spectrum disorder in tuberculosis

BMC Infect Dis. 2014 Aug 28:14:470. doi: 10.1186/1471-2334-14-470.

Abstract

Background: Neuromyelitis optica (NMO) is an autoimmune inflammatory condition of the central nervous system that is characterized by circulating anti-aquaporin-4 antibodies, transverse myelitis and optic neuritis. NMO spectrum disorders are rarely reported in patients with active pulmonary tuberculosis (TB). We report a fatal case of anti-aquaporin-4 antibody positive NMO spectrum disorder in a patient who was receiving treatment for pulmonary tuberculosis.

Case presentation: A previously healthy 42-year-old Chinese man was diagnosed with smear positive pulmonary tuberculosis. After one month of anti-tuberculosis treatment, he presented with acute generalized weakness and rapid neurological deterioration. Spinal imaging and anti-aquaporin-4 antibody positivity established a diagnosis of neuromyelitis optica spectrum disorder.

Conclusion: This is the first reported case of anti-aquaporin-4 antibody-positive NMO spectrum disorder in a patient with active tuberculosis. It shows the usefulness of testing for anti-aquaporin-4 antibodies while evaluating neurological deterioration in patients with tuberculosis. The literature on the rare association between NMO spectrum disorders and TB is reviewed.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aquaporin 4 / immunology*
  • Autoantibodies / blood*
  • Central Nervous System
  • Fatal Outcome
  • Hemodynamics
  • Humans
  • Male
  • Myelitis, Transverse / complications*
  • Myelitis, Transverse / diagnosis
  • Neuromyelitis Optica / complications*
  • Neuromyelitis Optica / diagnosis
  • Optic Neuritis
  • Tuberculosis, Pulmonary / complications*
  • Tuberculosis, Pulmonary / diagnosis

Substances

  • AQP4 protein, human
  • Aquaporin 4
  • Autoantibodies