A Case of Neuromyelitis Optica with Paraneoplastic Syndrome in Hepatocellular Carcinoma

Hyun Kyung Kil; Gu Eun Lee; Hyuk Jin Hong; Sang Jong Park; Sang Kun Sin

doi:10.3341/jkos.2013.54.10.1630

Journal List > J Korean Ophthalmol Soc > v.54(10) > 1009521

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Kil, Lee, Hong, Park, and Sin: A Case of Neuromyelitis Optica with Paraneoplastic Syndrome in Hepatocellular Carcinoma

Original Article

J Korean Ophthalmol Soc 2013;54(10):1630-1634.

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1630

A Case of Neuromyelitis Optica with Paraneoplastic Syndrome in Hepatocellular Carcinoma

Hyun Kyung Kil, MD¹, Gu Eun Lee, MD², Hyuk Jin Hong, MD³, Sang Jong Park, MD⁴, Sang Kun Sin, MD⁵

¹Department of Ophthalmology, DMC BunDang Je Sang General Hospital, Seongnam, Korea

²Department of Neurology, DMC BunDang Je Sang General Hospital, Seongnam, Korea

³Department of Radiology, DMC BunDang Je Sang General Hospital, Seongnam, Korea

⁴Department of Gastroenterology, DMC BunDang Je Sang General Hospital, Seongnam, Korea

⁵SinSangKun Neurologic Clinic, Seongnam, Korea

Address reprint requests to Hyun Kyung Kil, MD, Department of Ophthalmology, DMC BunDang Je Sang General Hospital, #20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 463-774, Korea, Tel: 82-31-779-0292, Fax: 82-31-779-0896, E-mail: hk9m@dmc.or.kr

Received 22 March 2013 Revised 12 June 2013 Accepted 24 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of neuromyelitis optica (Devic's syndrome) with hepatocellular carcinoma.

Case summary

A 70-year-old male with hepatocellular carcinoma presented with bilateral visual loss. A relative afferent pupillary defect was not observed in either eye due to bilateral mydriasis. On brain MRI, there was no specific finding, however, on spine MRI, multiple and severe myelopathies were observed. After high-dose methylprednisolone pulse therapy, the visual acuity was 0.03 in the right eye and counting fingers at 30 cm in the left eye.

Conclusions

We encountered a case of neuromyelitis optica involving bilateral optic neuropathy in hepatocelluar carcinoma. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing a systemic evaluation.

Keywords: Devic's syndrome, Hepatocellular carcinoma, Neuromyelitis optica, Optic neuritis

References

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Figure 1.

Liver CT scan of the patient at the initial visit. About 5.3 × 5.0 cm-sized round mass in the left lobe of the liver (expanding nodular type).

Figure 2.

Slit lamp photographs at the initial presentation. Both eyes show marked mydriasis.

Figure 3.

Fundus photographs at the initial presentation. There are no specific abnormalities in the retina of both eyes.

Figure 4.

Visual evoked potential (VEP) showing increased latency and decreased amplitude in his both eyes.

Figure 5.

Phillips Gyroscan 1.5T whole spine MRI shows multifocal ill-defined central high signal intensities in the spinal cord, T2- weighted images, C3-4, T2-3, T5-6, T8 and T11 levels (black arrow).

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