Elderly-Onset Neuromyelitis Optica which Developed after the Diagnosis of Prostate Adenocarcinoma and Relapsed after a 23-Valent Pneumococcal Polysaccharide Vaccination

Yu Kitazawa; Yoko Warabi; Mitsuaki Bandoh; Toshiyuki Takahashi; Shiro Matsubara

doi:10.2169/internalmedicine.51.5636

CASE REPORTS

Elderly-Onset Neuromyelitis Optica which Developed after the Diagnosis of Prostate Adenocarcinoma and Relapsed after a 23-Valent Pneumococcal Polysaccharide Vaccination

Yu Kitazawa, Yoko Warabi, Mitsuaki Bandoh, Toshiyuki Takahashi, Shiro Matsubara

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Keywords: neuromyelitis optica, multiple sclerosis, CD4-positive T cells, complement, anti-aquaporin-4 antibody, paraneoplastic syndrome

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 1 Pages 103-107

DOI https://doi.org/10.2169/internalmedicine.51.5636

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Abstract

We report a case of elderly-onset neuromyelitis optica (NMO) positive for the anti-aquaporin-4 (AQP-4) antibody; symptoms developed after the diagnosis of prostate adenocarcinoma and relapsed after a 23-valent pneumococcal polysaccharide vaccination. We suggest that activation of CD4-positive T cells and secretion of interferon-gamma induced by adenocarcinoma and complement activation induced by vaccination are responsible for the onset and relapse of NMO, even if a patient is positive for the anti-AQP-4 antibody. This case supports the previous experimental finding that the anti-AQP-4 antibody does not cause NMO-like lesions when injected alone, but does so after the induction of T cell-mediated experimental autoimmune encephalomyelitis or when co-injected with human complement.

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