Elderly-onset neuromyelitis optica which developed after the diagnosis of prostate adenocarcinoma and relapsed after a 23-valent pneumococcal polysaccharide vaccination.
We report a case of elderly-onset neuromyelitis optica (NMO) positive for the anti-aquaporin-4 (AQP-4) antibody; symptoms developed after the diagnosis of prostate adenocarcinoma and relapsed after a 23-valent pneumococcal polysaccharide vaccination. We suggest that activation of CD4-positive T cells and secretion of interferon-gamma induced by adenocarcinoma and complement activation induced by vaccination are responsible for the onset and relapse of NMO, even if a patient is positive for the anti-AQP-4 antibody. This case supports the previous experimental finding that the anti-AQP-4 antibody does not cause NMO-like lesions when injected alone, but does so after the induction of T cell-mediated experimental autoimmune encephalomyelitis or when co-injected with human complement.
Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
Yu
Y
Kitazawa
Yoko
Y
Warabi
Mitsuaki
M
Bandoh
Toshiyuki
T
Takahashi
Shiro
S
Matsubara
D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D001921:Brain / Q000473:pathology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D006801:Humans; D008213:Lymphocyte Activation; D008279:Magnetic Resonance Imaging; D008297:Male; D009471:Neuromyelitis Optica / Q000150:complications / Q000209:etiology* / Q000276:immunology; D020361:Paraneoplastic Syndromes, Nervous System / Q000209:etiology / Q000276:immunology; D059545:Paraneoplastic Syndromes, Ocular / Q000209:etiology / Q000276:immunology; D022242:Pneumococcal Vaccines / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D012008:Recurrence
C414006:23-valent pneumococcal capsular polysaccharide vaccine; C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D022242:Pneumococcal Vaccines