Authors: Joao Diogo Moreira Faustino , Eva Brandao , Raquel Vieira , Claudia Rosado

Abstract

Background: Longitudinal extensive transverse myelitis, which designates inflammation of the spinal cord in more than 3 vertical vertebral segments, is a rare presentation of paraneoplastic syndrome, being more common in lung or lymphoproliferative neoplasms. Before diagnosing myelitis of paraneoplastic etiology, the aim is to exclude inflammatory, metabolic, infectious and ischemic/traumatic causes.

Case Report: We present a 62-year-old man observed in the emergency department for low back pain that had lasted 2 weeks, paresthesia of the lower limbs and severe inability to walk. He also referred sphincter anesthesia in the previous 3 days. Several examinations were carried out and the dorso-lumbar magnetic resonance imaging highlighted findings of longitudinal extensive transverse myelitis from D5-D6 to the conus medullaris. The etiological study showed papillary thyroid carcinoma as a condition for this paraneoplastic syndrome. After thyroidectomy, the patient progressively recovered from the deficits presented.

Conclusions: The clinical and imaging diagnosis of myelitis is not difficult, however, finding the underlying etiology can be challenging. A whole set of laboratory and imaging tests are necessary to confirm the cause and direct treatment with the intention of potentially reversing the neurological condition.

Keywords: Longitudinal transverse myelitis; Paraneoplastic Syndrome; Papillary Thyroid Carcinoma; Nuclear Medicine