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Boyinepally K, Marellapudi A, Nawras Y, Fatima R, Altorok N. Therapeutic Management of Transverse Myelitis Secondary to Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Am J Ther 2024; 31:e505-e508. [PMID: 38976541 DOI: 10.1097/mjt.0000000000001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
| | | | - Yusuf Nawras
- University of Toledo College of Medicine, Toledo, OH; and
| | - Rawish Fatima
- Division of Rheumatology, Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Nezam Altorok
- Division of Rheumatology, Department of Internal Medicine, University of Toledo, Toledo, OH
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Hsing YH, Yang YC, Liao WC. Rapid Onset of Relapsing Longitudinally Extensive Transverse Myelitis After Lumbar Spinal Surgery. World Neurosurg 2022; 166:15-17. [PMID: 35803568 DOI: 10.1016/j.wneu.2022.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
Abstract
A 58-year-old woman experienced relapsing acute longitudinally extensive transverse myelitis that developed rapidly in 3 days after lumbar surgery. The patient had a history of systemic lupus erythematosus with acute transverse myelitis and had undergone plasmapheresis 16 years ago. New neurologic deficits including paraplegia of the lower limbs, sensory alterations, and bowel incontinence presented 3 days postoperatively. Magnetic resonance imaging revealed a long-segment hyperintense signal over the thoracic spine on T2-weighted imaging. Intravenous pulse therapy with high-dose corticosteroid was first used for 5 days but was ineffective. Plasmapheresis after pulse therapy resulted in improved neurologic deficit. The patient then underwent 6 months of rehabilitation therapy but was partially wheelchair bound. She no longer had bladder and bowel incontinence.
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Affiliation(s)
- Yueh-Han Hsing
- Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Chung Yang
- Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chuan Liao
- Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Oiwa H, Kuriyama A, Matsubara T, Sugiyama E. Clinical value of autoantibodies for lupus myelitis and its subtypes: A systematic review. Semin Arthritis Rheum 2018; 48:214-220. [DOI: 10.1016/j.semarthrit.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/28/2018] [Accepted: 02/12/2018] [Indexed: 11/25/2022]
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Abstract
Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD), previously known as Devic's syndrome, are a group of inflammatory disorders of the central nervous system (CNS) characterized by severe, immune-mediated demyelination and axonal damage, predominantly targeting optic nerves and the spinal cord typically associated with a disease-specific serum NMO-IgG antibody that selectively binds aquaporin-4 (AQP4). The classic and best-defined features of NMOSD include acute attacks of bilateral or rapidly sequential optic neuritis (leading to visual loss) or transverse myelitis (often causing limb weakness and bladder dysfunction) or both with a typically relapsing course. The diagnosis of NMO/NMOSD requires a consistent history and examination with typical clinical presentations, findings on spinal cord neuroimaging with MRI, cerebrospinal fluid analysis along with determination of AQP4-IgG serum autoantibody status, and exclusion of other disorders. Two major advances in this field has been the development of diagnostic criteria and treatment recommendations. Consensus diagnostic criteria have been established and were recently revised and published in 2015, enhancing the ability to make a diagnosis and appropriately evaluate these disorders. Expert recommendations and uncontrolled trials form the basis of treatment guidelines. All patients with suspected NMOSD should be treated for acute attacks as soon as possible with high-dose intravenous methylprednisolone -1 gram daily for three to five consecutive days and in some cases, plasma exchange should be used. It is recommended that every patient with NMOSD be started on an immunosuppressive agent, such as, azathioprine, methotrexate, or mycophenolate and in some cases, rituximab, soon after the acute attack and usually be treated for about 5 years after the attack. These advances have helped improve the prognosis and outcome in these disorders.
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Affiliation(s)
- Teresa M Crout
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
| | - Laura P Parks
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA
| | - Vikas Majithia
- Division of Rheumatology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA
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Piga M, Chessa E, Peltz MT, Floris A, Mathieu A, Cauli A. Demyelinating syndrome in SLE encompasses different subtypes: Do we need new classification criteria? Pooled results from systematic literature review and monocentric cohort analysis. Autoimmun Rev 2017; 16:244-252. [PMID: 28159705 DOI: 10.1016/j.autrev.2017.01.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe features of demyelinating syndrome (DS) in systemic lupus erythematosus (SLE). METHODS A systematic review using a combination of Mesh terms in PubMed and a retrospective analysis of 343 adult patients with SLE were carried out to identify patients with DS. Retrieved cases were classified as affected with DS according to 1999 ACR nomenclature and attributed to SLE by applying the 2015 algorithm. DS defined according to the clinical but not temporal 1999 ACR criteria was classified as clinically isolated syndrome (CIS). RESULTS Estimated prevalence of DS (including CIS) in the SLE cohort was 1.3% and incidence rate was 1.5 cases per 1000 patient-years. Overall, 100 cases from literature review and 4 from SLE cohort were identified and are presented as a whole: 49 (47.1%) were classified as neuromyelitis optica spectrum disorders (NMOSD), 29 (27.9%) as CIS, 14 (13.5%) as NMO, 7 (6.7%) as DS prominently involving the brainstem and 5 (4.8%) as DS prominently involving the brain. DS was the SLE onset manifestation in 41 (39.4%) patients. Longitudinally extensive transverse myelitis was the most frequent manifestations being present in 73 (70.2%) patients (37 NMOSD, 21 CIS, 14 NMO, 1 DSB). Methylprednisolone (79.8%) and cyclophosphamide (55.8%) pulses, but also plasma-exchange (16.3%) and rituximab (7.6%) in relapsing-refractory cases, were mostly prescribed. Complete recovery rate ranged between 62% in CIS to 7% in NMO. CONCLUSION DS in SLE is rare (1%) and encompasses different subtypes including CIS. Timely diagnosis and early treatment are recommended to minimize complications.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | - Elisabetta Chessa
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy
| | | | - Alberto Floris
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy
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Alkan G, Emiroğlu M, Kartal A, Peru H, Koplay M. Occult Disseminated Tuberculosis with Holocord Longitudinally Extensive Transverse Myelitis: A Rare Phenomenon in a Child. J Pediatr Neurosci 2017; 12:259-261. [PMID: 29204202 PMCID: PMC5696664 DOI: 10.4103/jpn.jpn_14_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Longitudinally extensive transverse myelitis (LETM) is defined as an inflammatory lesion of the spinal cord that extends to three or more segments. LETM is a commonly characteristic feature of neuromyelitis optica (NMO) or various autoimmune diseases. Manifestation of Mycobacterium tuberculosis (MTB) infection with LETM are rare and usually in the cervicothoracic spinal cord. Our patient presented with holocord LETM, so NMO was considered initially diagnosis. After in further research, MTB was diagnosed and treated successfully. The current case underscores that tuberculosis must be keep in mind when undertaking differential diagnosis of demyelinating diseases even in the absence of symptoms of infection, and especially in endemic regions.
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Affiliation(s)
- Gülsüm Alkan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Melike Emiroğlu
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ayşe Kartal
- Department of Pediatric Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Harun Peru
- Department of Pediatric Nephrology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Faculty of Medicine, Selcuk University, Konya, Turkey
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Jain RS, Kumar S, Mathur T, Tejwani S. Longitudinally extensive transverse myelitis: A retrospective analysis of sixty-four patients at tertiary care center of North-West India. Clin Neurol Neurosurg 2016; 148:5-12. [DOI: 10.1016/j.clineuro.2016.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/28/2016] [Accepted: 06/13/2016] [Indexed: 01/07/2023]
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Young V, Quaghebeur G. Transverse Myelitis and Neuromyelitis Optica Spectrum Disorders. Semin Ultrasound CT MR 2016; 37:384-95. [PMID: 27616312 DOI: 10.1053/j.sult.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transverse myelitis is defined as inflammation of the spinal cord, named because of its typical clinical presentation with bandlike symptoms of altered sensation or pain in a horizontal fashion-at a specific dermatome level. Radiographic patterns might vary but the idiopathic form is more frequent to present as involvement of 3-4 vertebral segments and both sides of the cord. It is now recognized that there are numerous other causes as well as the idiopathic type, with often atypical features and geographic variation. There is also increasing recognition of other forms of myelitis, particularly the longitudinally extensive manifestation with involvement of 3 or more vertebral segments. Neuromyelitis optica, one of these subtypes can be diagnosed by means of an antibody assessment. The picture is more complicated with the expansion of the description to involve neuromyelitis optica spectrum disorders, new antibodies such as myelin oligodendrocyte glycoprotein and the inclusion of an antibody-negative variant. This article describes the different entities of transverse myelitis, with a particular focus on neuromyelitis optica spectrum disorders.
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Affiliation(s)
- Victoria Young
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gerardine Quaghebeur
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Duarte JA, Henriques CC, Sousa C, Alves JD. Lupus or syphilis? That is the question! BMJ Case Rep 2015; 2015:bcr-2015-209824. [PMID: 26045520 DOI: 10.1136/bcr-2015-209824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old man presented with fever, a maculopapular rash of the palms and soles, muscular weakness, weight loss, faecal incontinence, urinary retention and mental confusion with 1 month of evolution. Neurological examination revealed paraparesis and tactile hypoesthesia with distal predominance, and no sensory level. Laboratory investigations revealed a venereal disease research laboratory (VDRL) titre of 1/4 and Treponema pallidum haemagluttin antigen (TPHA) of 1/640, positive anti-nuclear antibodies of 1/640 and nephrotic proteinuria (3.6 g/24 h). Lumbar puncture excluded neurosyphilis, due to the absence of TPHA and VDRL. The diagnosis of systemic lupus erythematosus (SLE) was established and even though transverse myelitis as a rare presentation of SLE has a poor outcome, the patient improved with cyclophosphamide, high-dose corticosteroids and hydroxychloroquine. A diagnosis of secondary syphilis was also established and the patient was treated with intramuscular benzathine penicillin G.
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Affiliation(s)
- Joana Azevedo Duarte
- Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal
| | - Celia Coelho Henriques
- Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal Department of Internal Medicine 2, Curry Cabral Hospital, Lisbon, Portugal
| | - Carolina Sousa
- Department of Pneumology, Fernando Fonseca Hospital, Amadora, Portugal
| | - José Delgado Alves
- Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal
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Nardone R, Fitzgerald RT, Bailey A, Zuccoli G. Longitudinally extensive transverse myelitis in systemic lupus erythematosus: Case report and review of the literature. Clin Neurol Neurosurg 2015; 129:57-61. [DOI: 10.1016/j.clineuro.2014.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 11/04/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
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Li XY, Xiao P, Xiao HB, Zhang LJ, Pai P, Chu P, Chan TM. Myelitis in systemic lupus erythematosus frequently manifests as longitudinal and sometimes occurs at low disease activity. Lupus 2014; 23:1178-86. [PMID: 24972897 DOI: 10.1177/0961203314541690] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transverse myelitis (TM) is a relatively infrequent but severe complication in systemic lupus erythematosus (SLE). Owing to its rarity and unfavorable outcome, we investigated its general features on MRI and incidence in the context of lupus activity, to facilitate early recognition and treatment. Methods We report a case of a young man with clinically inactive lupus nephritis but who presented with a sudden attack of myelitis. We performed systematic literature search in Medline to study the clinical features of SLE-related TM. Results From 1960 to April 2013, a total of 72 articles containing 194 cases of lupus myelitis were found. Among acquired articles, 93 patients fulfilled the inclusion criteria. The majority of the cases (88.8%) were female. Longitudinal myelitis was the predominant imaging finding on MRI (71.4%, 45/63). Nearly two-thirds (61/94) of lupus myelitis occurred in association with active lupus, and one-third (33/94) occurred in low disease activity. Conclusions Upon literature review, we found myelitis in SLE more frequently manifested as longitudinal on MRI. Although lupus myelitis often presented at an active phase of SLE, one-third of events happened in the presence of low disease activity. Early initiation of effective immunosuppressive therapy facilitated recovery.
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Affiliation(s)
- X-Y Li
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - P Xiao
- Department of Gastroenterology, Nanshan Affiliated Hospital of Guangdong Medical College, Shenzhen, China
| | - H-B Xiao
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - L-J Zhang
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - P Pai
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - P Chu
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - T-M Chan
- Department of Nephrology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
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Abstract
PURPOSE OF REVIEW This article discusses the specific neurologic issues that arise in patients with rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome. Diagnosis and management are discussed. RECENT FINDINGS Advances include advanced imaging, serologic and CSF markers, and targeted immune-modulating therapies. The use of these modalities are discussed in detail. SUMMARY Rheumatic disorders are quite common and can result in disabling but many times treatable neurologic sequelae. The key is early diagnosis and management. Awareness of the common presentations and current modalities of diagnosis and treatment is critical to improved outcomes.
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Kimbrough DJ, Mealy MA, Simpson A, Levy M. Predictors of recurrence following an initial episode of transverse myelitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2014; 1:e4. [PMID: 25340060 PMCID: PMC4202674 DOI: 10.1212/nxi.0000000000000004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 12/02/2022]
Abstract
Objective: This study sought to identify factors that increased the risk of recurrence after an initial transverse myelitis (TM) presentation. Methods: Retrospective cohort study of 192 patients initially presenting with TM of unknown etiology. Patients diagnosed with multiple sclerosis during the first myelitis episode were excluded. Demographic and laboratory data were analyzed for associations with recurrence. Results: One hundred ten of 192 patients (57%) eventually developed recurrent symptoms: 69 (63%) neuromyelitis optica (NMO) or NMO spectrum disorder, 34 (31%) non-NMO recurrent TM, and 7 (6%) systemic autoimmune disease. Multiple independent risk factors for recurrence were identified: African American race (risk ratio 1.60, p < 0.001, 95% confidence interval 1.26–2.03; similarly noted hereafter), female sex (1.88, p = 0.007, 1.19–2.98), longitudinally extensive myelitis at onset (1.34, p = 0.036, 1.01–1.78), Sjogren syndrome antigen A (1.89, p = 0.003, 1.44–2.48), vitamin D insufficiency (4.00, p < 0.001, 1.60–10.0), antinuclear antibody titer ≥1:160 (1.69, p = 0.006, 1.23–2.32), and the presence of inflammatory markers (e.g., immunoglobulin G index) in the CSF (2.14, p < 0.001, 1.44–3.17). Conclusions: Sex, race, and serologic biomarkers warrant consideration when assessing risk of TM recurrence. Male sex and Caucasian American race were independently associated with risk of monophasic idiopathic TM. Recurrence risk in female and African American patients appears driven by a greater likelihood of developing NMO or NMO spectrum disorder.
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Affiliation(s)
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | | | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD
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Longitudinally extensive transverse myelitis with intramedullary metastasis of small-cell lung carcinoma: an autopsy case report. Case Rep Neurol Med 2014; 2013:305670. [PMID: 24455343 PMCID: PMC3881446 DOI: 10.1155/2013/305670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/28/2013] [Indexed: 12/05/2022] Open
Abstract
Background. Longitudinally extensive transverse myelitis (LETM) is characterized by spinal cord inflammation extending vertically through three or more vertebral segments. The widespread use of MRI revealed LETM more frequency than ever. We report the case of a patient with pathologically confirmed small-cell lung carcinoma metastasis into the spinal cord presenting as LETM. Case Presentation. A 74-year-old man developed rapidly progressive sensorimotor disturbance and vesicorectal dysfunction. T2-weighted magnetic resonance imaging of the spine revealed LETM at the level of from T3 to conus medullaris; gadolinium enhancement showed concurrent tumor in the thoracic spinal cord from T10 to T11. Systemic survey identified a nodular mass in the lung that was verified as small-cell carcinoma. Following initial failed treatment by high-dose steroid, the patient underwent an emergent microsurgical tumor resection. Histological examination was identical with the lung carcinoma. The patient died of tumor progression at the 47th day after admission. At autopsy, only changes of edema were found in the gray matter of the cord, while tumor cells were not noted in it. Conclusion. Metastasis may rarely present symptoms of LETM. Prompt identification of underlying etiology by contrast examination and systemic survey is crucial for the patient assumed as LETM.
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