Intractable nausea and vomiting as an uncommon presentation in an anti-aquaporin 4-positive patient

Autoantibodies targeting aquaporin 4 (AQP4) water channels are a sensitive and specific biomarker for neuromyelitis optica spectrum disorder (NMOSD). Presence of AQP4 antibodies distinguishes NMOSD from multiple sclerosis. We present our experience with an anti-AQP4 antibody-positive patient diagnosed with NMOSD who complained of intractable nausea and vomiting, not restricted to optic neuritis or acute myelitis during the first attack. Her symptoms partially resolved after appropriate therapy with intravenous methylprednisolone and oral prednisolone. Through this case, we hope to draw attention to an unusual neurological presentation of NMOSD which should be included in the differential diagnosis of intractable nausea and vomiting.