Eosinophilic myelitis associated with atopic diathesis: A combined neuroimaging and histopathological study

Manabu Osoegawa, Hirofumi Ochi, Hitoshi Kikuchi, Susumu Shirabe, Tatsuya Nagashima, Tomoyuki Tsumoto, Yoji Tamura, Kazutoshi Yamabe, Hiroshi Takahashi, Toru Iwaki, Jun Ichi Kira

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Abstract

Histologically proven eosinophilic myelitis has rarely been reported except in connection with parasitism. To clarify its clinicopathological features, we conducted a nationwide survey of biopsy-proven eosinophilic myelitis of unknown cause throughout Japan. Six such cases were collected and studied immunologically and pathologically. All were young to middle-aged men. All showed a protracted and fluctuating course with mild disability for 3-25 (mean 12.5) months before biopsy. Magnetic resonance imaging revealed localized lesions of T2-high and T1-iso signal intensity with a partial gadolinium enhancement in all cases. Cerebrospinal fluid (CSF) examinations were completely normal except for modest pleocytosis in two cases. Eosinophilia was present in the peripheral blood in two cases but was absent from the CSF of all cases. In spite of the chronic nature of the disease, spinal cord pathology revealed very active lesions with marked cell infiltration consisting mainly of CD8+ T cells and varying numbers of eosinophils in the perivascular areas and the parenchyma. Both the myelin and axons were severely disrupted in all cases. Moreover, eosinophil cationic protein (ECP), an activated eosinophil product, was heavily deposited in the tissues. All but one case had hyperIgEemia and mite antigen-specific IgE in the sera, and two had accompanying atopic disorders. The present study thus revealed idiopathic eosinophilic myelitis to be a localized and persistent inflammation of the spinal cord, with distinct clinicopathological features, that has a possible link to atopic diathesis.

Original languageEnglish
Pages (from-to)289-295
Number of pages7
JournalActa neuropathologica
Volume105
Issue number3
Publication statusPublished - Mar 1 2003

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All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this

Osoegawa, M., Ochi, H., Kikuchi, H., Shirabe, S., Nagashima, T., Tsumoto, T., ... Kira, J. I. (2003). Eosinophilic myelitis associated with atopic diathesis: A combined neuroimaging and histopathological study. Acta neuropathologica, 105(3), 289-295.