PMC8328144_01
Timeline of clinical course, diagnostic testing, treatment, and biomarker sampling.
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F1
A 54-year-old female with a 39-pack-year history of tobacco use and a history of rheumatoid arthritis presented to an outside hospital with a history of progressive lower extremity weakness (Figure 1 for timeline of events).
(A,B) MRI demonstrating an longitudinally extensive T2 lesion (top row; thick white arrow) with associated contrast enhancement (bottom row; thick white arrow). Box (a), axial view showing a typical presence of transverse myelitis involving a central lesion, involving more than 2/3 of the cross-sectional area (thin white arrow). Box (b), areas of patchy contrast enhancement concentrated within areas of the posterior cord (thin white arrow). (C,D) Patient had clinical and radiographical improvement at 4 months after diagnosis following acute treatment with plasma exchange, high-dose steroids, and adjuvant chemotherapy. (E,F) Seven months after diagnosis and 1 month following completion of her adjuvant chemotherapy, she was hospitalized again for worsening of lower extremity weakness and pain. Repeat cervical spine MRI showed some worsening T2 signal change within the cord (thick white arrow) with no evidence of contrast enhancement. Acute therapy with plasma exchange and intravenous steroids were given over 5 days followed by rituximab induction (1,000 mg on days 0 and 14). Additional cancer screening with full body PET scan remained negative with clinical relapse.
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F2
Magnetic resonance imaging (MRI) showed a contrast-enhancing, longitudinally extensive lesion from C3 down to T12 (Figure 2). Repeat spinal imaging demonstrated resolution of contrast enhancement and improved T2 signal change (Figure 2).