Leukopenia and D4 Spinal Lesion

by

Miguel A Ibaņez

I Have seen a 29 y old female.  She has a leukopenia of unknown origin from 1992. 

October of 1999:  Numbness, paresthesias and dysesthesias from D4 to distal L2, also in the 4 extremities, more in the lower ones.  Doctors suspect Lupus, and she was given Methylprednisolone. 

April of 1999:  Termoalgesic anesthesia in left inferior member, July in the right inferior member too, and dysfunction of sphincters.  She receives Azatioprina in combination with Deltisona B 40 (Oral methilprednisolone). 

November 1999:  Neurological examination presented only abolition of cutaneous abdominal reflex and pallanesthesia in inferior members.  The corticoids were tapered.

July 2000:  Sensory dysfunction in neck and superior members.  Because she was leukopenic, Azatioprina is suspended. 

October 2000:  Paraplegia level D4 and sphincter dysfunction.  Plasmapheresis without results is made.  She does not tolerate cyclosporin. 

November 29, 2000:  She arrives at my hospital with worse sensory level (right: C4, left: C6), quadriparesis, hypotonic paralysis with synkinesias in the lower extremities and the following studies: MRI column lumbosacra normal lumbar Column dorso hyperintense focales Injuries in T2 intramedulares from D1 to D6.  Cervical column puntiformes injuries in union to bulbomedular of C2 to C4 boards with heightens to medular the Normal resistance subsequent to Brain VEP.  Normal BAER Normal SEP Normal ? RWC: 1720 Hto: 45% Plaquetas: 224000 VSG 52 mm Ac.antiphospholipids (-) C3 and C4 (-) Latex for AR (-) Anti RNP (-) Anti SM (-) Anti SS - B (-) Anti SS - A (-) FAN (+) 1/100 homogenous Proteins. 6.76 Albumen 4.30 Anti antiHTLV I/II (-) Anti HVBs, HVBc, (-) HVA IgG(+) IgM (-) Biopsy MO: conserved with linfopenia of 7% CSF: proteins 10 mg/dl Glucose 50 mg/dl Leukocytes 2/mm3 Inmunoelectroforesis: weak albumen band Without oligoclonal bands VDRL (-) Dosaje de Vit B12 and Folic Ac pending.

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Revised December 9, 2000

(c) 2000 Medical College of Georgia