A case of neuromyelitis optica spectrum disorder with coexisting systemic lupus erythematosus

Figures & data

Table 1. Admission labs

Laboratory findings	Result	Normal Range
WBC	5.47	4–10 x 10(3)/μl
Hemoglobin	13.9	11.2–15.7 g/dl
Platelets	274	163– 369x 10(3)/μl
Sodium	139	136−144 meq/L
Potassium	3.8	3.5–5.1 meq/L
Chloride	107	98–110 meq/L
Bicarbonate	22	20–30 meq/L
BUN	7	7–23 mg/dL
Creatinine	0.73	0.57–1.11 mg/dL
Glucose	101	70–99 mg/dL
calcium	9.3	8.5–10.3 mg/dL
AST	16	5–42 units/L
ALT	6	5–49 units/L
Total bilirubin	0.4	0.1–1.2 mg/dL
Alkaline phosphatase	67	35–141 units/L
Phosphorus	3.5	2.3–4.7 mg/dL
Total protein	7.2	6.1–8.3 g/dL

WBC: White Blood cell (mg/dl = milligram per deciliter; g = gram; L = liter; mmol = millimoles; meq = milliequivalent)

Image 1,2. MRI cervical spine with contrast. Arrow shows contrast enhancement of thickened region of cervical cord from cervicocranial junction to C5-6

Table 2. Additional labs

ANA profile	Result	Normal Range
SS–A IgG Ab	0.3	0.2-0.9 AU/ml
SS–B IgG Ab	<0.2	0.2–0.9 AU/ml
SM IG Ab	0.6	0.2–0.9 AU/ml
RNP IgG Ab	>8.0 high	0.2-0.9 AU/ml
SCL–70 IgG Ab	<0.2	0.2-0.9 AU/ml
JO–1 IgG Ab	<0.2	0.2-0.9 AU/ml
dsDNA Ab	10.0 high	1–4 IU/ml
Centromere IgG Ab	<0.2	0.2–0.9 AU/ml
Chromatin IgG Ab	3.6 high	0.2–0.9 AU/ml
Ribosomal P IgG Ab	0.3	0.2–0.9 AU/ml
Sm RNP IgG Ab	>8.0 high	0.2–0.9 AU/ml

ANA: AntiNuclear Antibody; Anti ds DNA: double-stranded DNA; Anti RNP: Anti ribonucleoprotein; SM – Smooth Muscle.

Table 3. CSF analysis

CSF analysis	Result
CSF color	Colorless
CSF Turbidity	Clear
Xanthochromia	Negative
White blood cells	68/mm3 high
Red Blood cells	1/mm3
Neutrophils	1%
Lymphocytes	93% high
Glucose	76 mg/dl
Protein	38 mg/dl
IgG	6.9 mg/dl
Oligoclonal bands	Negative
Myelin Basic Protein	24(H) normal 0-5.5
NMO AQP4- IgG NMO IFA	Positive Positive 1:1000
Flow Cytometry	No CD19-positive B-cell population identified. Markedly increased CD4:CD8 ratio of 24
cytology	Negative for malignant cells. No definite blast population
Lyme by Rapid PCR B. burgdorferi B. mayonii B. garinii/B. afzelii	Negative
Cultures	Negative
Meningitis/encephalitis PCR panel	Negative

PCR– Polymerase chain reaction

Table 4. Imaging studies

MRI Cervical w/Contrast	Enhancement of the thickened region of the cervical spinal cord extending from the craniocervical junction to C5-C6
MRI Thoracic w/wo Contrast	No thoracic spinal canal stenosis or cord signal abnormality.
MRI Lumbar spine w/wo contrast	Mild to moderate bilateral neural foraminal narrowing at L4-L5 and L5-S1
CT Thorax/abdomen/pelvis	No appreciable lung malignancy or evidence of metastatic disease is identified.

CT: Computed Tomography; MRI: Magnetic Resonance Imaging

Table 5. Core clinical characteristics as per international consensus diagnostic criteria for neuromyelitis optica spectrum disorders

Optic neuritis
Acute Myelitis
Area postrema syndrome: episode of otherwise unexplained hiccups or nausea and vomiting
Acute brainstem syndrome
Symptomatic narcolepsy or acute diencephalic clinical syndrome with NMOSD-typical diencephalic MRI lesions
Symptomatic cerebral syndrome with NMOSD-typical brain lesions

Data availability

From the patient’s chart and PUBMED.