%0 Journal Article
%T An Unusual Case of Subclinical Peripheral Neuropathy and Cervical Spondylosis in Atopic Myelitis
%A Alev Leventoglu
%A Pelin Ozlu
%A Ferda Ince
%J Case Reports in Neurological Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/489451
%X Many cases of atopic myelitis have been reported in Japan; however very few were described in western countries. An 82-year-old woman with a past medical history of atopic dermatitis and asthma presented with progressive paresthesia (tingling) of both hands and tetraparesis. Before the onset of neurological symptoms, she complained of ichthyosis of both legs for 5 weeks. Magnetic resonance imaging demonstrated multisegmental degenerative arthritis, degenerative disc disease, and abnormal spinal cord signal intensity over several cervical segments, suggesting the diagnosis of myelitis. Total serum IgE level was elevated. Nerve conduction studies revealed asymmetric axonal sensorimotor neuropathy. The cerebrospinal fluid specimen showed lymphocytic pleocytosis and elevated protein level. Based on clinical, imaging, and laboratory findings, atopic myelitis was diagnosed. The diagnosis of atopic myelitis should be considered in myelopathy patients with history of atopy and elevated serum IgE levels. 1. Introduction Atopy is characterised by an overactive immune response to environmental factors such as house dust mites, pollens, and foods and can be complicated with various neurological disorders, such as Hopkins¡¯ syndrome [1, 2], Hirayama disease [3, 4], idiopathic myelitis [5¨C8], peripheral neuropathy [9¨C11], and cervical spondylosis (intervertebral disc degeneration) [12]. These conditions are described to the association between allergic inflammation and central/peripheral nervous system disease and in part relate to the atopic backgrounds. In 1997 Kira et al. first reported four patients with cervical myelitis associated with atopic dermatitis (AD) and hyperIgEaemia, and they named the disease ¡°atopic myelitis¡± (AM) [7]. The characteristic features of AM are (1) predominantly involvement of the cervical cord, as seen on MRI scans, (2) stepwise progression and fluctuation of the symptoms, (3) paresthesia/dysesthesia as the initial and predominant symptoms, (4) frequent coexistence with atopic dermatitis, (5) persistence of neurologic symptoms and MRI lesions (6) mild motor weakness, (7) normal or mildly cerebrospinal fluid (CSF) abnormalities, (8) absence of oligoclonal IgG bands and normal IgG index, (9) hyperIgEaemia, (10) presence of mite antigen-specific IgE, (11) mild peripheral blood eosinophilia, and (12) eosinophilic inflammation on spinal cord biopsy [6, 13, 14] Most cases of AM have been reported in Japan since 1997, and nearly very few patients have been described in western countries [15¨C17]. We present a novel elderly case of atopic
%U http://www.hindawi.com/journals/crinm/2013/489451/