Vomiting in Neuromyelitis Optica: An Atypical Presentation

Neuromyelitis Optica (NMO), also known as Devic's disease, is a demyelinating disorder of the central nervous system (CNS) that majorly involves the optic nerves and the spinal cord. It is an idiopathic and an autoimmune disorder. The patient typically presents with symptoms pertaining to the eye or spinal cord, such as a decrease in visual acuity, visual field defects, pain in the eyes, loss of vision, numbness, and weakness of the limbs with or without bladder dysfunction. Vomiting, however, is an atypical presentation of this disorder. We report here a case of an 18-year-old female who presented to our tertiary care set-up with a one-month history of intractable non-bilious vomiting and dull epigastric pain. After going through several initial investigations and being discharged home, she returned after five days with complaints of intractable vomiting, double vision and inability to stand or walk. Later, the presence of anti-NMO antibodies led to the diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD). Through this case, we highlight the importance of considering NMO in a patient presenting with intractable vomiting to enable prompt diagnosis and treatment of the disease, thus preventing further disability.