Neuromyelitis optica spectrum disorder and active tuberculosis

Grieve, James Kerr; Day, Scott; Connell, David; O’Riordan, Jonathan

doi:10.1136/bcr-2019-231524

Cited by 6 publications

(5 citation statements)

References 22 publications

(28 reference statements)

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“…In one case, a patient in the initial phase of her TB therapy had an NMO relapse which was treated with IVMP followed by oral prednisolone. 5 Luckily this patient did not have reactivation. Steroids have also been used for NMOSD in the setting of chronic HBV as well.…”

Section: Discussionmentioning

confidence: 78%

Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report

Sadowsky

Delijani

Davis

et al. 2023

The Neurohospitalist

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Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory autoimmune disorder of the central nervous system, with optic neuritis and transverse myelitis as its most common presentations. Although immunomodulatory treatment options for NMOSD have expanded, preventing reactivation of latent infections in patients can be both a therapeutic challenge and a special consideration for the neurohospitalist in an inpatient setting. We present a challenging case of a NMOSD patient who presented to the emergency department with worsening weakness and numbness in the setting of an NMOSD pseudo-relapse, later found to have untreated latent tuberculosis (TB) and chronic hepatitis B (HBV). She was briefly treated with high-dose IV methylprednisolone, which was stopped after her symptoms and imaging became more consistent with a pseudo-relapse. After confirmation that neither HBV nor TB had reactivated, the patient was discharged on isoniazid and entecavir. A month later, the patient’s symptoms were stable, and she was started on inebilizumab for relapse prevention of NMOSD. This case report is the first to highlight the therapeutic complexities of managing NMOSD that requires immunosuppression in the setting of preventing reactivation of both TB and HBV.

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Section: Discussionmentioning

confidence: 78%

Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report

Sadowsky

Delijani

Davis

et al. 2023

The Neurohospitalist

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“…Just in South Africa, a higher proportion 6 of active pulmonary tuberculosis in NMO patients compared with healthy controls has been described (79% vs. 14%, P = 0.0013 < 0.05) [ 42 ]. This has been reported in different populations across the world [ 42 , 43 , 44 , 45 , 46 , 47 ]. Our phylogenetic analysis showed that aquaporin from Mycobacterium sp .…”

Section: Finding the Genesis: Cross Reactivity And Molecular Mimicry ...mentioning

confidence: 54%

AQP4 as a vintage autoantigen: what do we know till now?

Múnera¹,

Buendía²,

Sánchez³

et al. 2022

Heliyon

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“…Recently, a case of NMOSD manifesting during the initial phase of AT in a female patient was treated with rituximab in cyclic infusions with a favorable outcome [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…After the discovery of anti-AQP4ab, a small number of reports, involving diagnoses of concomitant [ 5 , 9 , 10 ] or associated [ 4 , 11 , 12 ] NMOSD and pulmonary tuberculosis (PT) have been published. For associated NMOSD and PT, the neurological symptoms attributed to both the central nervous system (CNS) due to NMOSD and to PT dissemination into CNS defined the conditions.…”

Section: Introductionmentioning

confidence: 99%

“…For associated NMOSD and PT, the neurological symptoms attributed to both the central nervous system (CNS) due to NMOSD and to PT dissemination into CNS defined the conditions. PT symptoms often shortly precede NMOSD manifestations [ 5 , 9 , 12 ], suggesting that Mycobacterium tuberculosis (MT) infects the pulmonary parenchyma weeks or months prior to the onset of NMOSD signs [ 13 ]. The pathophysiological relationship between PT and NMOSD is not yet established.…”

Section: Introductionmentioning

confidence: 99%

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Neuromyelitis optica and concomitant pulmonary tuberculosis: a case report

et al. 2021

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Background Concomitant diagnosis of neuromyelitis optica spectrum disease and pulmonary tuberculosis has rarely been reported. Case report We report a case involving a young Tunisian male patient who developed dry cough followed, 2 months later, by weakness in the lower limbs. The findings of central nervous system imaging and anti-aquaporin-4 antibody positivity were compatible with the diagnosis of neuromyelitis optica spectrum disease. Constellation of the clinical and the typical radiological pulmonary findings in our patient, coming from an endemic region, allowed the diagnosis of pulmonary tuberculosis, although sputum smear examination for acid-fast bacilli and cultures was negative. The patient received anti-tuberculous polytherapy associated with immunomodulation, consisting of methylprednisolone and intravenous immunoglobulins. Pulmonary infection symptoms initially improved but with no motor recovery. The patient suddenly died at home 4 months after the onset of the first symptoms. Current data regarding the clinical presentation of this underreported concomitant or associated condition, the possible pathophysiological mechanisms, and the therapeutic options were reviewed. Conclusions This case underscores the necessity to understand the exact mechanism of these coincident entities and to clarify the best immunomodulatory choice since immunosuppression targeting neuromyelitis optica spectrum disease can lead to dissemination of pulmonary tuberculosis.

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Neuromyelitis optica spectrum disorder and active tuberculosis

Cited by 6 publications

References 22 publications

Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report

Neuromyelitis Optica Spectrum Disorder Management in the Setting of Chronic Hepatitis B and Latent Tuberculosis: A Case Report

AQP4 as a vintage autoantigen: what do we know till now?

Neuromyelitis optica and concomitant pulmonary tuberculosis: a case report

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