Title:A Case Report of NMO Transverse Myelitis
Volume: 20
Issue: 2
Author(s): Anna Lafian, Tandis Mahani, Mehrnaz Hojjati*Taraneh Sarlati
Affiliation:
- Division of Rheumatology, Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda,
California, USA
Keywords:
Transverse myelitis, West Nile Virus, NMOSD, CSF, immune-mediated demyelination, axonal damage.
Abstract:
Background: Transverse myelitis is considered one of the cardinal features of neuromyelitis
optica spectrum disorder (NMOSD), an immune-mediated inflammatory condition of
the CNS characterized by severe, immune-mediated demyelination and axonal damage predominantly
targeting optic nerves and spinal cord. We describe a case in which a diagnosis of NMOSD
was established, associated with West Nile Virus (WNV) infection.
Case Presentation: A healthy 18-year-old female presented with intractable hiccups and rapidly
progressing paraparesis. MRI demonstrated T2 edema extending from the medulla to the conus,
consistent with longitudinally extensive transverse myelitis. Serum and CSF Aquaporin-4 IgG
(AQP4) were both positive with high titers. In conjunction with antiviral therapy, immunomodulatory
treatment was initiated using pulse methylprednisolone, plasmapheresis and Rituximab. A
month and a half after admission, the patient was fully ambulatory with no residual symptoms. On
her rheumatology follow-up visit, West Nile Virus-specific IgM in CSF was found to be positive
from the patient’s initial presentation.
Conclusion: We propose that West Nile Virus may have been the autoimmune trigger to the patient’s
development of NMOSD, highlighting the importance of evaluating viral triggers in autoimmune
diseases.
