[Acute transverse myelitis presenting with syrinx formation associated with anti-sulfated glucuronyl lactosaminyl paragloboside antibody and anticardiolipin antibody].
A 37-year-old woman was admitted because of rapidly progressive unsteady gait, back pain and ascending dysesthesia below the lower chest level. On admission, she showed ataxic gait, positive Romberg's sign, severely impaired deep sensation of lower extremities, and vesico-rectal disturbance. Deep tendon reflexes in both lower extremities were brisk, while normal in the upper extremities. Babinski's sign was positive on both sides. On laboratory data, antinuclear antibody, immune complex and the low titer of IgG anticardiolipin antibody as well as IgM anti-sulfated glucuronyl lactosaminyl paragloboside (SGLPG) antibody were positive in her serum. Cerebrospinal fluid showed pleocytosis and increased protein level, but no oligoclonal IgG bands. The posterior tibial nerve SEP showed no P39 peak with normal latency of N20. Spinal MRI revealed mild cord swelling and syrinx formation at T7 to T9 level. Steroid therapy including pulse therapy with methylprednisolone was effective. The present case was diagnosed as acute transverse myelitis (ATM) similar to lupoid sclerosis, and to the best of knowledge, the first case of ATM with anti-SGLPG antibody. It is speculated that the autoimmune mechanism with anti-SGLPG antibody and anticardiolipin antibody by reacting with the endothelial cells in the central nervous system might contribute to causing ATM in our case.
Inoue
Y
Y
Department of Neurology, Toyama Prefectural Central Hospital, Japan.
Yoshino
H
H
D000208:Acute Disease; D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D017153:Antibodies, Anticardiolipin / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis*; D005260:Female; D005915:Globosides / Q000276:immunology*; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D009188:Myelitis, Transverse / Q000276:immunology*
D000888:Antibodies, Anti-Idiotypic; D017153:Antibodies, Anticardiolipin; D001323:Autoantibodies; D005915:Globosides; D007075:Immunoglobulin M; C064938:3-sulfoglucuronyl-lactosaminyl-paragloboside