Anti-tuberculosis treatment for Devic’s neuromyelitis optica

Feng, Yanqing; Guo, Ning; Fan, Huimin; Chen, Xi; Sun, Qin; Liu, Junxiu

doi:10.1016/j.jocn.2010.02.023

Cited by 27 publications

(25 citation statements)

References 15 publications

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“…In a small controlled study carried out by Feng and colleagues from China, positivity for M. tuberculosis DNA in the CSF of 2 out of 12 steroid-refractory NMO patients (confirmed using nested polymerase chain reaction and the long-term clinical efficacy of anti-tuberculosis treatment in these patients) suggested pathogenesis involves direct CNS infection [9]. However, it is possible that Feng et al’s study may have been subjected to selection bias because the authors used the original criteria for NMO diagnosis (Wingerchuck 1999), which did not require NMO-IgG data, and their patients showed a high rate of CSF abnormalities (CSF protein levels were increased in 53.9% of patients and 50% had elevated CSF leukocyte counts) [9]. The present study used the newer, revised criteria that are more specific for NMO diagnosis than the original criteria [10].…”

Section: Discussionmentioning

confidence: 99%

“…Another study, also carried out in South Africa, suggested PTB-associated NMO developed in patients with active infection because 79% (11/14) of NMO patients had a preceding or simultaneous diagnosis of PTB [8]. Finally, Feng and colleagues described the benefits of anti-tuberculosis treatment in steroid-refractory Chinese NMO patients [9]. …”

Section: Introductionmentioning

confidence: 99%

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Association between neuromyelitis optica and tuberculosis in a Chinese population

Zhong

Qiu

et al. 2014

BMC Neurol

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BackgroundA number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients. However, a definite association between the two conditions has not been conclusively demonstrated.MethodsTo investigate the association between NMO and TB in a Chinese population, we performed a retrospective review of hospital records of NMO patients, control patients and tuberculosis meningitis (TBM) patients from January 1, 1995 to December 31, 2011.ResultsThe frequency of preceding/simultaneous active pulmonary TB (PTB) was not significantly different between NMO patients (1.1%) and control groups (2.3% in myasthenia gravis, 1.1% in polymyositis or dermatomyositis, zero in idiopathic facial palsy and viral meningitis/meningoencephalitis). NMO cases differed from TBM cases in terms of demographics, course (recurrent or monophasic), cerebrospinal fluid analysis and magnetic resonance images. Two TBM patients shared partial clinical features with NMO (one of the TBM patients had a longitudinal extensive spinal cord lesion involving the holocord, and the other had optic neuritis before anti-tuberculosis treatment). NMO antibodies were only detected in NMO patients and not in TBM patients with myelitis or optic neuritis.ConclusionsWe could not confirm previous suggestions of the association between PTB and NMO. Direct infection of the central nervous system by TB may mimic NMO in some respects, but whether NMO-like symptoms that develop during the course of TB should be considered and diagnosed as NMO is open to discussion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between neuromyelitis optica and tuberculosis in a Chinese population

Zhong

Qiu

et al. 2014

BMC Neurol

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“…While one study found a significant association between NMO and TB in a high TB – low NMO prevalence setting in South Africa, another study in an intermediate TB – high NMO prevalence setting in southern China failed to demonstrate a significant association [10, 11]. However, a clinical trial conducted in another Chinese NMO patient group demonstrated a marked beneficial effect of anti-TB treatment on the course of patients with steroid refractory NMO even in the absence of overt tuberculosis suggesting a possible association of latent TB with NMO that would have been missed in the case–control studies [12]. Therefore, the evidence to date is in favor of an association with TB in a subset of NMO patients, who may benefit from anti-TB treatment.…”

Section: Introductionmentioning

confidence: 99%

Fatal anti-aquaporin-4 seropositive neuromyelitis optica spectrum disorder in tuberculosis

2014

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BackgroundNeuromyelitis optica (NMO) is an autoimmune inflammatory condition of the central nervous system that is characterized by circulating anti-aquaporin-4 antibodies, transverse myelitis and optic neuritis. NMO spectrum disorders are rarely reported in patients with active pulmonary tuberculosis (TB). We report a fatal case of anti-aquaporin-4 antibody positive NMO spectrum disorder in a patient who was receiving treatment for pulmonary tuberculosis.Case presentationA previously healthy 42-year-old Chinese man was diagnosed with smear positive pulmonary tuberculosis. After one month of anti-tuberculosis treatment, he presented with acute generalized weakness and rapid neurological deterioration. Spinal imaging and anti-aquaporin-4 antibody positivity established a diagnosis of neuromyelitis optica spectrum disorder.ConclusionThis is the first reported case of anti-aquaporin-4 antibody-positive NMO spectrum disorder in a patient with active tuberculosis. It shows the usefulness of testing for anti-aquaporin-4 antibodies while evaluating neurological deterioration in patients with tuberculosis. The literature on the rare association between NMO spectrum disorders and TB is reviewed.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-470) contains supplementary material, which is available to authorized users.

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“…However, their diagnostic efficacy are usually be questioned by their specificity for distinguishing CNS TB from other CNS disease. Several other CNS diseases [10,20] had been found to be associated with mycobacteria infection over the past 3 years. Therefore neurologist should be aware of the limitations to the notion of "sensitivity and specificity" about MTB PCR tests.…”

Section: Discussionmentioning

confidence: 99%

Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients

Guo¹,

Huang²,

Chen³

et al. 2013

OJMN

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Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic challenge using conventional workup. However, this disease should not be overlooked because it is essentially curable with proper diagnosis and therapy, usually, a Mycobacterium Tuberculosis (MTB) DNA test is performed. Methods: We retrospectively analyzed the clinical presentations, CSF results, and images of 11 MTB DNA positive and clinically cured cases of infratentorial tuberculoma. Results: Infratentorial tuberculoma usually deteriorated before antituberculosis treatment (ATT). Magnetic resonance imaging showed space-occupying lesions without specific features, 4 within the cerebellum and 7 within the brainstem. Evidence of systemic tuberculosis was found in only 1 case. Clinical manifestations included various combinations of focal signs and symptoms in the brain stem and cerebellum. Cerebrospinal fluid (CSF) findings were also nonspecific. The diagnoses of these cases were based on the positive tests of a nested polymerase chain reaction (N-PCR) assay. Trial therapy with antituberculous drugs resulted in clinical improvement, as documented by MRI in all patients. Conclusions: Infratentorial tuberculoma should be suspected in patients with infratentorial space-occupying lesions who live in geographic areas where tuberculosis is endemic.

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Anti-tuberculosis treatment for Devic’s neuromyelitis optica

Cited by 27 publications

References 15 publications

Association between neuromyelitis optica and tuberculosis in a Chinese population

Association between neuromyelitis optica and tuberculosis in a Chinese population

Fatal anti-aquaporin-4 seropositive neuromyelitis optica spectrum disorder in tuberculosis

Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients

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