Abstract Details

Title Anti-Neurofascin Antibodies, White Matter Abnormalities and Cancer: Caught in the Act or Innocent By-Stander?

Topic Multiple Sclerosis

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-005

Background Neurofascin is a nodal/paranodal cell adhesion molecule existing in different isoforms. ANFAs can result in secondary demyelination in the peripheral and/or central nervous system. We report here a case of multiple sclerosis-like disease associated with ANFAs and lung cancer.

Objective To report a case of demyelinating disease of the central nervous system (CNS) associated with anti-neurofascin antibodies (ANFAs) and cancer.

Design/Methods Single case-study

Results A 71-year old Caucasian woman with history of heavy smoking presented with a five-year history of imbalance. Brain and spine MRI fulfilled the 2017 McDonald’s MRI criteria for dissemination in time and space and demonstrated recurrent contrast enhancing lesions over two years. Extensive workup demonstrated a low titer P/Q type calcium channel antibody (0.15 nmol/L; reference range £ 0.02 nmol/L). Cerebrospinal fluid (CSF) analysis showed an increase in IgG index and synthesis rate and 12 CSF-unique oligoclonal bands. Due to her advanced age and continuous disease activity, ANFAs were tested in serum and returned positive for anti-NF 140 IgG, and 155 IgM and IgG. The co-existence of several autoantibodies raised the suspicion of cancer. A PET scan demonstrated a right pulmonary nodule highly suggestive of bronchogenic carcinoma. Further workup is in progress to determine its histopathology.

Conclusions

The clinical spectrum of ANFAs-associated demyelination has broadened to include several types of inflammatory neuropathies, CNS demyelination, and combined central and peripheral demyelination (CCPD). Our case emphasizes several points. First, significant disease activity in a patient with an MS-like disease and advanced age should prompt the search for an alternative diagnosis. Second, the presence of several autoantibodies should call for a malignancy workup. Third, the pathogenic significance of different isoforms and isotypes of ANFAs remains to be further clarified. Last, further research is warranted to determine if ANFAs-associated CNS demyelination may be a paraneoplastic phenomenon.

Authors/Disclosures
Rana K. Zabad, MD, FAAN (University of Nebraska Medical Center) PRESENTER	Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene/BMS. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Neurosciences. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. The institution of Dr. Zabad has received research support from Adamas. The institution of Dr. Zabad has received research support from Biogen. The institution of Dr. Zabad has received research support from Novartis. The institution of Dr. Zabad has received research support from Sun Pharma. The institution of Dr. Zabad has received research support from Parexel & MedDay Pharmaceuticals.
Navnika Gupta, MBBS	Dr. Gupta has nothing to disclose.
Afsaneh Shirani, MD (University of Nebraska Medical Center)	Dr. Shirani has nothing to disclose.