Herpes Zoster Radiculomyelitis With Aquaporin-4 Antibodies: A Case Report and Literature Review
Autor: | Haruka Takeshige, Yasushi Shimo, Jiro Fukae, Sho Nakajima, Asuka Nakajima, Masayoshi Kanou, Hideto Miwa, Hiroto Eguchi, Atsuto Fuse |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
medicine.medical_specialty viruses Myelitis Azathioprine herpes zoster lcsh:RC346-429 Virus 03 medical and health sciences myelitis 0302 clinical medicine Cerebrospinal fluid medicine case report lcsh:Neurology. Diseases of the nervous system Neuromyelitis optica integumentary system business.industry neuromyelitis optica spectrum disorder virus diseases medicine.disease Dermatology Hyperintensity aquqporin-4 immunoglobulin G 030104 developmental biology Aquaporin 4 medicine.anatomical_structure Dermatome Neurology Neurology (clinical) sense organs business 030217 neurology & neurosurgery medicine.drug |
Zdroj: | Frontiers in Neurology Frontiers in Neurology, Vol 11 (2020) |
ISSN: | 1664-2295 |
Popis: | Background: The relationship between varicella-zoster virus (VZV)-associated myelitis and aquaporin-4 immunoglobulin-G (AQP4-IgG) remains unknown.Case Report: We report a case of acute radiculomyelitis with longitudinal extensive hyperintensity signals traversing the brainstem until the upper thoracic cord in a 55-year-old healthy woman following herpes zoster infection in the left C4-T3 dermatome. VZV-specific IgG in the cerebrospinal fluid (CSF) and AQP4-IgG positivity on enzyme-linked immunosorbent assay (ELISA) were undetectable. Thus, she was diagnosed with immune-competent VZV radiculomyelitis. Forty-two months later, she experienced a relapse, and AQP4-IgG positivity was detected on ELISA. A cell-based assay (CBA) showed AQP4-IgG positivity not only at the time of recurrence but also retrospectively at 1 month after the initial symptoms. We concluded that AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) was concurrent with VZV myelitis. After the second attack, she was treated with azathioprine and has had no relapse since then.Conclusion: We reported a case of VZV radiculomyelitis with confirmed concurrent AQP4-IgG positivity. NMOSD induced by herpes zoster has been recently identified, but distinguishing it from VZV myelitis can be difficult and whether these two diseases aggravate each other is unknown. Awareness of the potentially varied presentation of VZV myelitis can enable earlier recognition and proper treatment. |
Databáze: | OpenAIRE |
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