Abstract Details

Title Atypical Cerebrospinal Fluid Findings in Neuromyelitis Optica Relapse Mimicking Meningitis

Topic MS and Related Diseases

Presentation(s) P02 - (-)

Poster/Presentation
Number 143

Objective

Background BACKGROUND: Several case series have identified CSF pleocytosis as a consistent marker of the disease in some patients. The largest series of patients with serum-antibody positive NMO found that 50% of CSF samples demonstrated pleocytosis with a range of 6-380 white blood cells (WBC)/[micro]l. However, severe pleocytosis, defined as CSF WBC > =100 cells/[micro]l was present in only 6% of this series.

Design/Methods DESIGN/METHODS: We present a case of a young woman with aquaporin-4 antibody positive NMO who presented with markedly severe CSF pleocytosis in the absence of CNS infection and in the setting of a relapse.

Results RESULTS: A 27 year old woman with a history of aggressive NMO presented with acute onset of paraplegia and urinary retention. She was being treated with Rituximab and received her last dose 5 months prior. Magnetic resonance imaging of her cervical spine revealed a confluent, contrast-enhancing lesion from C2-C7. She was treated with intravenous steroids and plasma exchange. One day into her hospitalization, she developed headache and fever. CSF revealed 1000 WBC/[micro]l with a neutrophilic predominance, 80 red blood cells (RBC)/[micro]l, protein of 5420 mg/dl and glucose of 287 mg/dl. Viral PCRs and culture, bacterial culture, and fungal culture were negative. She was found to have a urinary tract infection.

Conclusions CONCLUSIONS: Relapses in NMO may be associated with severe CSF pleocytosis mimicking the profile of bacterial CNS infection.

Authors/Disclosures
PRESENTER	No disclosure on file
Susan Gauthier, DO (Weill Cornell Medicine)	Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Gauthier has received research support from Genentech.
Nancy M. Nealon, MD (Cornell Medical Center)	Dr. Nealon has nothing to disclose.
Timothy K. Vartanian, MD, PhD (Weill Cornell Medical College)	Dr. Vartanian has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Vartanian has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Vartanian has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Vartanian has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tisch MS Center. Dr. Vartanian has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen.
Jai Perumal, MD	Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for T G therapeutics. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono.
David Miller	No disclosure on file

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