Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2023; 11(34): 8192-8199
Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8192
Anti-glial fibrillary acidic protein antibody and anti-aquaporin-4 antibody double-positive neuromyelitis optica spectrum disorder: A case report
Ting-Yu Jin, Bing-Tong Lin, Li-Jv Dai, Xia Lu, Han Gao, Jin Hu
Ting-Yu Jin, Bing-Tong Lin, Li-Jv Dai, Xia Lu, Han Gao, Jin Hu, Department of Neurology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Author contributions: Jin TY and Hu J contributed to manuscript writing and editing, and data collection; Lin BT, Dai LJ, Lu X, and Gao H contributed to data collection; Lin BT contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Supported by Hospital Level Project of Jiaxing First Hospital, No. 2022-YB-034.
Informed consent statement: The study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin Hu, Doctor, Researcher, Department of Neurology, First Affiliated Hospital of Jiaxing University, detailed address, such like the neighborhood and house number, Jiaxing 314000, Zhejiang Province, China. hujin19771110@163.com
Received: September 18, 2023
Peer-review started: September 18, 2023
First decision: November 9, 2023
Revised: November 20, 2023
Accepted: November 29, 2023
Article in press: November 29, 2023
Published online: December 6, 2023
Abstract
BACKGROUND

A case of neuromyelitis optica spectrum disorder (NMOSD) with positive cerebrospinal fluid (CSF) anti-aquaporin-4 antibody (AQP4-IgG) and anti-glial fibrillary acidic protein IgG (GFAP-IgG) at the time of relapse was reported. The exact roles of GFAP-IgG in NMOSD are not fully understood and are the subject of ongoing research. This study revealed the possible connection between GFAP-IgG and the occurrence or development of diseases.

CASE SUMMARY

A 19-year-old woman was admitted to the hospital due to a constellation of symptoms, including dizziness, nausea, and vomiting that commenced 1 year prior, reoccurred 2 mo ago, and were accompanied by visual blurring that also began 2 mo ago. Additionally, she presented with slurred speech and ptosis, both of which emerged 1 mo ago. Notably, her symptoms deteriorated 10 d prior to admission, leading to the onset of arm and leg weakness. During hospitalization, magnetic resonance imaging showed high T2-fluid attenuated inversion recovery signals, and slightly high and equal diffusion-weighted imaging signals. The serum antibody of AQP4-IgG tested positive at a dilution of 1:100. CSF antibody testing showed positive results for GFAP-IgG at a dilution of 1:10 and AQP4-IgG at a dilution of 1:32. Based on these findings, the patient was diagnosed with NMOSD. She received intravenous methylprednisolone at a daily dose of 500 mg for 5 d, followed by a tapering-off period. Afterward, the rate of reduction was gradually slowed down and the timely use of immunosuppressants was implemented.

CONCLUSION

The CFS was slightly GFAP-IgG-positive during the relapse period, which can aid in the diagnosis and treatment of the disease.

Keywords: Anti-glial fibrillary acidic protein antibody, Neuromyelitis optica spectrum disorder, Anti-aquaporin-4 antibody, Cerebrospinal fluid, Case report

Core Tip: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disorder that affects the central nervous system. Here, a case of NMOSD with positive cerebrospinal fluid aquaporin-4 antibody and anti-glial fibrillary acidic protein antibody (GFAP-IgG) at the time of the relapse was reported. The exact role of GFAP-IgG in NMOSD remains a subject of debate and research, with some studies suggesting it is pathogenic and plays a role in disease development or progression. This case reveals the potential role of GFAP-IgG in NMOSD. The findings suggest a possible association between GFAP-IgG and the initiation or advancement of the disease.