J Korean Neurosurg Soc.  2012 Oct;52(4):410-413. 10.3340/jkns.2012.52.4.410.

Eosinophilic Myelitis in the Cervical Cord Mimicking Intramedullary Cord Tumor

• Park CW
• Choe WJ
• Chun YI

• KMID: 2190662
• DOI: http://doi.org/10.3340/jkns.2012.52.4.410

Abstract

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.

Keyword

Allergy; Eosinophilic myelitis; Intramedullary tumor; Toxocariasis

MeSH Terms

Diagnosis, Differential
Eosinophils
Hypersensitivity
Immunoglobulin E
Mites
Myelitis
Rare Diseases
Spinal Cord
Toxocariasis
Immunoglobulin E

Figure

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  Fig. 1 A : A T2 weighted magnetic resonance (MR) sagittal image shows a high signal intensity lesion and swelling in the cervical spinal cord at the level of C3-6. B : A follow-up MR after three months reveals an aggravated high signal intensity lesion and cord swelling in C2-7. C : Contrast-enhanced T1 axial image shows focal nodular enhancement on posterior segment of spinal cord at the level of C5.

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  Fig. 2 Histologic findings of biopsy specimens from spinal cord, C5 level. Numerous infiltration of chronic, mixed inflammatory cells such as lymphocytes, histiocytes, and plasma cells are found diffusely on microscopic examination (×100, H&E) (A). Specially, infiltration of eosinophils is conspicuous (×400, H&E) (B). Immunohistochemical staining of glial fibrillary acidic protein (C) and neurofilament (D) shows disruption of neuroglial tissues suggesting inflammation.

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  Fig. 3 A : A high signal intensity lesion and mild cord swelling was observed in C4-6 on T2 weight MRI. B : A nodular enhancement confined to posterior column was found at C5 level. C : After systemic steroid and albendazole medication, markedly decreased extent of HSI lesion and decreased swelling of spinal cord are observed after three months. D : The extent of nodular enhancing lesion is also decreased. MRI : magnetic resonance imaging, HSI : high signal intensity.

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