Intractable pruritus in neuromyelitis optica

Neuromyelitis optica (NMO) is an immune-mediated disease of the central nervous system. Pruritus in patients with NMO has rarely been reported. We aimed to explore the characteristics and underlying mechanisms of pruritus in NMO patients. We reviewed the case records of 64 NMO patients who visited the Department of Neurology at the Third Hospital of Sun Yat-sen University between 2009 and 2015. Of the 64 aquaporin-4 antibody-positive NMO patients, 18 had pruritus. Spinal magnetic resonance imaging (MRI) showed lesions in all of these patients. A total of 13 patients presented with brain lesions, and four had lesions in the periaqueductal gray matter on cerebral MRI. However, the anatomical distribution of pruritus did not always correspond to the dermatomal distributions of the involved spinal cord segments. Pruritus was completely or partially relieved after treatment. Pruritus is not a rare occurrence and may be a characteristic feature of NMO.