Paraneoplastic neuromyelitis optica associated with fever of unknown origin as an early manifestation: A case report

Abstract

Tumors have been frequently reported to be associated with neuromyelitis optica (NMO). Here we review a case of a 34-year-old woman who presented with complaint of one-sided visual loss. All Lab tests exhibited negative results which decreased the possibility of Auto-immune or neuro-inflammatory disorders. Magnetic resonance imaging (MRI) of the brain and spinal cord was done as a part of work up, which showed Meningioma in anterior fossa without any other findings supporting neuro-demyelinating disorders. After complete surgical removal of the meningioma, patient's visual loss was completely resolved. 4 weeks later, she was admitted to the hospital for the second time with fever fulfilling the Fever of Unknown Origin (FUO) criteria. One week after she was discharged, she came back with paraplegia. MRI with Gadolinium showed an enhancing lesion involving T6-T9 segments of the thoracic spine. In order to rule in NMO, we checked for antibody to aquaporin-4 (AQP4-Ab) and the result was positive. This is the first report showing a probable association between FUO and NMO. Our case also demonstrates how variable the clinical presentations of NMO can be. We suggest that the diagnosis of NMO should be considered in the appropriate clinical setting despite of the presence of unconventional manifestations.