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She received multiple lines of anti\u2010neoplastic treatment, including immunotherapy with pembrolizumab, as well as cytotoxic chemotherapy. Paraneoplastic meningoencephalomyelitis developed 2\u2009years after diagnosis of breast cancer and 1\u2009year after discontinuation of immunotherapy with pembrolizumab. She first developed longitudinally extending transverse myelitis followed by left optic neuritis and meningoencephalitis with new enhancing lesions in the brain and spinal leptomeninges. Cerebrospinal fluid analysis during both episodes showed normal glucose and protein, and elevated white blood cell count. Cytology was negative for malignancy. Cerebrospinal fluid was positive for neuromyelitis optica immunoglobulin\u2009G antibody anti\u2010aquaporin\u20104, and autoimmune myelopathy panel was positive for myelin oligodendrocyte glycoprotein antibody. The patient had significant clinical and radiographic improvement after completion of five cycles of plasmapheresis followed by intravenous immunoglobulin. She did not have recurrence of paraneoplastic syndrome with maintenance rituximab every 6\u2009months and daily low\u2010dose prednisone. She succumbed to progressive systemic metastatic disease 4.5\u2009years after her breast cancer diagnosis. This case shows that these antibodies can occur concurrently and cause clinical features, such as both neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody disease, in a patient with a singular type of cancer. We highlight the importance of testing for paraneoplastic etiology in cancer patients with radiographic menigoencephalomyelitis or meningitis with atypical symptoms of meningeal carcinomatosis and\/or cerebrospinal fluid profile negative for leptomeningeal carcinomatosis.<\/jats:p>","DOI":"10.1111\/cen3.12767","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T07:49:41Z","timestamp":1695023381000},"page":"55-60","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Anti\u2010aquaporin\u20104 <scp>immunoglobulin\u2009G<\/scp>\/anti\u2010myelin oligodendrocyte glycoprotein <scp>immunoglobulin\u2009G<\/scp> double\u2010positive paraneoplastic neurological syndrome in a patient with triple\u2010negative breast cancer"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-3928","authenticated-orcid":false,"given":"Amna","family":"Siddiqui","sequence":"first","affiliation":[{"name":"Department of Neurology of Loyola University Stritch School of Medicine  Maywood Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9858-9815","authenticated-orcid":false,"given":"Dylan","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Neurology of Loyola University Stritch School of Medicine  Maywood Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5687-6488","authenticated-orcid":false,"given":"Ronak H.","family":"Jani","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery of Loyola University Stritch School of Medicine  Maywood Illinois 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