Gray matter predominant Longitudinally Extensive Transverse Myelitis: a rare association with metastatic Papillary Thyroid Carcinoma. (P5.123)

This is a case report of a 29 year old female with a history of granulomatosis with polyangitis, focal segmental glomerulosclerosis s/p living related donor kidney transplant in 2000 presented with bronchitis, low grade fevers and productive cough which progressed to neck stiffness prior to admission. Lumbar puncture showed WBC of 73 (13[percnt] lymph, 29[percnt] mono), RBC 17, protein 52, glucose 54. She was initially started on acyclovir and ceftriaxone. Two days later, patient noticed right hand weakness, right facial droop and additionally LUE weakness. Over the course of the night, patient started to develop upper and lower extremity paralysis as well as diaphragmatic paralysis requiring intubation. Repeat LP was as follows: glucose of 54, Protein 110 and WBC 136 with a lymphocytic predominance. Paraneoplastic panel, autoimmune and infectious workup negative. MRI brain showed Flair hyper-intensities in the deep gray nuclei and leptomeningeal enhancement of the ventral medulla and gray matter of cervical cord. MRI spine showed extensive abnormal T2 hyper-intense signal affecting the entire spinal cord, most concentrated at the anterior horns of the central gray matter, with linear intramedullary enhancement within the cervical spinal cord. Patient responded minimally to steroids 1g for 10 days and PLEX for 7 days. Multiple cystic appearing lymph nodes within the left neck measuring approximately 1.5 cm in size were incidentally discovered on MRI. Biopsy of this lesion wa...
Source: Neurology - Category: Neurology Authors: Tags: Ischemia, Myelitis, and Vascular Malformations Source Type: research