A case of paraneoplastic myelopathy associated with the neuromyelitis optica antibody.
BACKGROUND
A 63-year-old woman with a history of metastatic breast cancer presented to the emergency department with chest pain in a band-like distribution. Within 1 day of presentation the patient developed bilateral lower-extremity weakness and urinary retention. The emergence of these symptoms coincided with the recurrence of her metastatic breast cancer. Fifteen months before presentation the patient had experienced a similar episode of myelopathy in the setting of recurrence of her breast cancer, from which she recovered completely following treatment with steroids.


METHODS
General and neurological examination, routine laboratory testing, MRI of the brain and spine, tests for serum autoimmune antibodies, infectious serology testing, lumbar puncture, paraneoplastic panel, neuromyelitis optica antibody testing, evaluation for celiac disease, CT scans of the chest, abdomen and pelvis, whole-body [(18)F]fluoro-2-deoxyglucose PET scan, lymph node biopsy, electroencephalography observing visual and brainstem auditory evoked potentials, and neuro-ophthalmological examination.


METHODS
Myelopathy, possibly paraneoplastic, associated with the neuromyelitis optica antibody in the setting of metastatic breast cancer.


RESULTS
Corticosteroids to treat the myelopathy and chemotherapy for the breast cancer.
Mueller
Sabine
S
University of California San Francisco, San Francisco, CA 94143, USA.
Dubal
Dena B
DB
Josephson
S Andrew
SA
D001323:Autoantibodies / Q000096:biosynthesis* / Q000097:blood*; D001943:Breast Neoplasms / Q000150:complications / Q000276:immunology / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D020361:Paraneoplastic Syndromes, Nervous System / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013904:Thoracic Vertebrae / Q000473:pathology
D001323:Autoantibodies