Context: Neuromyelitis optica spectrum disorders (NMOSDs) are autoimmune disorders resulting from astrocytic aquaporin–4 (AQP–4) channelopathy in young adults. The AQP–4 IgG antibodies may be present in the context of some paraneoplastic disorders which should be suspected when NMOSD occur in elderly patients.
Findings: This study reported a case of 65-year-old male patient with paraneoplastic NMOSD. The patient presented with quadriparesis due to acute cervical long segment myelitis not responsive to pulse steroid therapy; 18 months later he developed acute bilateral diminution of visual acuity due to bilateral optic neuritis with no response to either pulse steroid therapy or IVIG. Serological serum tests revealed that the patient was AQP–4–IgG positive, but after 22 months of the initial presentation, the patient showed widespread metastasis in bone and liver secondary to bronchogenic carcinoma.
Conclusion: Late onset of NMOSD should raise the suspicion of paraneoplastic neurological disorder, and extensive work up is advised to identify the underlying neoplasm.

PDF (Download Full text)