Longitudinally extensive transverse myelitis as presenting manifestation of small cell carcinoma lung

Abstract

Longitudinally extensive transverse myelitis (LETM) is an unusual manifestation of systemic malignancy. It has been mainly reported with lung cancers and lymphoproliferative malignancy. LETM in systemic malignancy can be caused by either intramedullary metastases or paraneoplastic syndrome. We report an unusual case of small-cell carcinoma lung, who presented with LETM without having any cardinal manifestations of lung malignancy. This case report highlights the important differentiating features between intramedullary metastasis and paraneoplastic syndrome.

Figure 1:

Sagittal T₂-weighted and post-contrast MR images of the spine showing hyperintense signal in spinal cord from C-2 to T-3 vertebral level (a), heterogeneous predominantly hypointense signal from T-4 to T-9 level (b) with abnormal contrast enhancement (c).

Figure 2:

T₂-weighted axial MR images of brain showing hemorrhagic intra axial lesion associated with moderate to severe edema in bilateral frontal lobes (a), left parietal region (b) and right cerebellar hemisphere (c).

Figure 3:

CT scan thorax showing large lobulated mass lesion in suprahilar location in right upper lobe.