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Open Access Case report

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

Siddharth Sridhar1, Jasper Fuk-Woo Chan123 and Kwok-Yung Yuen123*

Author Affiliations

1 Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China

2 State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China

3 Research Centre of Infection and Immunology, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China

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BMC Infectious Diseases 2014, 14:470  doi:10.1186/1471-2334-14-470

Published: 28 August 2014

Abstract

Background

Neuromyelitis 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 presentation

A 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.

Conclusion

This 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.

Keywords:
Tuberculosis; Neuromyelitis optica; Anti-aquaporin-4 antibody