Re: A woman with acute myelopathy in pregnancy: case progression
Aquaporin is amongst a family regulatory transport of water in central nervous system . A new autoantibody found AQP4-Ab, NMO-IgG has been described in neuromyelitis optic (NMO), transverse myelitis and recurrent optic neuritis. During the acute phase the spinal cord develops diffuse swelling over multiple spinal segments. Also associated with this are perivascular inflammatory infiltration. The pattern of tissue inflammation in early demyelination with a unique perivascular pattern suggested a role of humoral autoimmunity in the pathogenesis of disease. The autoantibody is associated with many autoimmune disease such as systemic lupus erythematosus, sjogren syndrome, autoimmune thyroiditis, type I diabetes mellitus, myasthenia gravis where B cell activation is suggested . However, one of the studies done in South America nullifies the association of aquaporin-4 antibodies with neurological manifestation in sjogren syndrome . A disease like lupus may also cause central nervous system involvement, the coexistence may reflect a predisposition of patients with NMO to multiple autoimmune disease. Seropositivity of aquaporin-4 antibody can help differentiate between systemic lupus erythematosus nervous system involvement and NMO (neuromyelitis optica) . Thus, in conclusion, myelitis and optic neuritis in a patient with lupus should alert the co-existence of NMO for testing the presence of aquaporin-4 antibody.
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