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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 153-154

Neuromyelitis optica with fluorosis: An association or coincidence


Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru 560 029, Karnataka, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Faheem Arshad
Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2241_19

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How to cite this article:
Arshad F, Ramakrishnan S. Neuromyelitis optica with fluorosis: An association or coincidence. Indian J Med Res 2020;152, Suppl S1:153-4

How to cite this URL:
Arshad F, Ramakrishnan S. Neuromyelitis optica with fluorosis: An association or coincidence. Indian J Med Res [serial online] 2020 [cited 2021 Jul 31];152, Suppl S1:153-4. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/153/316790

Patient's consent obtained to publish clinical information and images.


A 46 yr old female presented to the Neurology Emergency department in the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India, with myelopathy, nausea and vomiting of two weeks duration in the month of October 2018. The patient had flexion deformities in upper limbs and thoracolumbar scoliosis with bulbar dysfunction, hypophonia and quadriparesis (power 0-–1/5). On evaluation, the patient was diagnosed as seropositive neuromyelitis optica (NMO) as neuroimaging features were characteristic [Figure 1]A and [Figure 1]B. The patient was managed with intravenous steroids for five days, followed by oral steroids. In addition, there were ossification of the posterior longitudinal ligament (OPLL), interosseous membrane calcification [Figure 2] and osteosclerosis of axial bones [Figure 3], findings consistent with diagnosis of fluorosis, which is now rarely seen or underdiagnosed and can also present with compressive myelopathy, as in this patient adding to diagnostic confusion. She made minimal improvement with steroids and plasmapheresis and was on long long-term follow up. Prompt investigations helped in identifying the underlying dual pathology, avoidance of toxic immunomodulators and also in prognostication in this patient.
Figure 1: (A) Magnetic resonance imaging (MRI) spine sagittal T2 showing long-segment differential hyperintensities in central cervical cord involvement extending up to the medulla (arrow). (B) Axial MRI T2-weighted image showing bright T2 spotty lesion (arrow) characteristic of neuromyelitis optica.

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Figure 2: X-ray of bilateral forearm showing calcification of interosseous membrane (arrow).

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Figure 3: X-ray of spine anteroposterior and lateral views showing osteosclerosis of axial bones.

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Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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