ABSTRACT
Objective To study the clinical and imaging characteristics of Chinese atopic myelitis (AM) patients.Methods Three diagnosed AM patients were retrospectively analyzed for the clinical data,serum IgE level,antigen specific IgE,cerebrospinal fluid,spinal MRI and therapeutic efficacy profiles.Results All the three patients were male and presented as subacute AM with the onset at 25,47 and 49 years old respectively.Two patients were allergic to pollen and other drugs,while another patient suffered from allergic rhinitis.Elevated serum total IgE and mite antigen specific IgE were found in all cases.Paraesthesia in limb extremities and positive Lhermitte sign were the main clinical features,while no optic,motor,urinary and defecation disturbance were found.Oligoclonal banding of cerebrospinal fluid and serum aquaporin 4 (AQP4) antibody were both negative in all cases.Spinal MRI showed lesions were hypointense on T1 and hyperintense on T2 at the posterior column of T2-3 segment with abnormal enhancement in case 1,hypointense on T1 and hyperintense on T2 at C2/3 segment with mild swelling in case 2 and hypointense on T1 and hyperintense on T2 at C3-5 segments with swelling and abnormal enhancement in case 3.Vitamin B were used in one patient,while the other two patients improved after the treatment with high-dose corticosteroids.Conclusions Subacute myelitis predominantly presents as paraesthesia in limb extremities with elevated serum total IgE and mite antigen specific IgE,while severe motor disorders are rare.Swelling and abnormal enhancement lesions at the posterior column of cervical cord are the common imaging features.Treatment with corticosteroids is recommended to be sustained for 3-6 months.
ABSTRACT
We report a patient displaying several symptoms of myelitis associated with atopic dermatitis. The patient, a 35-year-old female, initially suffered from gait titubation that gradually developed into motor disturbance. She underwent many tests (blood, cerebrospinal fluid, electromyography, and brain, cervical, and lumbar spinal cord and muscle MRIs) at several hospitals, including a university institution, over the course of two years until she finally came to our hospital. However, her disease was never identified by these tests, and she was referred to our hospital to start rehabilitation for her disability which was believed to be caused by disuse syndrome. On first examination, muscle hypertonia of both legs, hypoesthesia of all extremities, difficulty sitting, and a low performance level of ADL were observed. Judging by the factors (e.g. age, neurological symptoms), we considered that the patient was not suffering disuse syndrome, and recommended that she attend another medical college hospital for a thorough investigation. The disease was finally diagnosed as atopic myelitis, as indicated by the test results (e.g. hyperIgEemia). She could sit without a back rest and undertake gait training between parallel bars after steroid pulse therapy at the hospital. While she undertook rehabilitation at our hospital, we applied some approaches to adapt to her fluctuating symptoms (e.g. making short leg braces for both legs, injection of botulinum toxin A (BOTOX<sup>®</sup>) in the leg). We recognized we should gather as much information as possible given the rarity of the disease.
ABSTRACT
Atopic myelitis is defined as myelitis of unknown cause with either hyperIgEaemia and mite antigen-specific IgE positivity or coexistent atopic diseases such as atopic dermatitis, allergic rhinitis, and bronchial asthma. Atopic myelitis was shown to preferentially affect young males and the cervical spinal cord. We report a rare case of atopic myelitis which occurred in a child. A 13-year-old male had typical history of atopic dermatitis. He developed paresthesia and numbness of both upper extremities with the upper limb muscle weakness. The magnetic resonance imaging scans showed localized inflammation in the cervical cord. The cerebrospinal fluid findings were normal and oligoclonal immunoglobulin G bands were absent. Treatment with intravenous methylprednisolone obtained clinical improvement. The location of the lesion in the cervical cord on the magnetic resonance imaging and the past history of atopic dermatitis should be suggestive of atopic myelitis.
Subject(s)
Adolescent , Child , Humans , Male , Asthma , Dermatitis, Atopic , Hypesthesia , Immunoglobulin E , Immunoglobulin G , Inflammation , Magnetic Resonance Imaging , Methylprednisolone , Mites , Muscle Weakness , Myelitis , Paresthesia , Rhinitis , Rhinitis, Allergic, Perennial , Spinal Cord , Upper ExtremityABSTRACT
Myelitis is caused by various infectious organisms or an autoimmune mechanism. We report two cases of myelitis with increased serum total IgE and mite antigen specific IgE. The patients had paresthesia and Lhermitte's signs without weakness nor bladder dysfunctions. A spine MRI revealed a T2-high signal lesion with focal enhancement in the upper cervical cord. The patients showed favorable responses to steroid treatment. Atopic myelitis should be considered as a form of myelitis.