Neuromyelitis optica spectrum disorder after post appendectomy peritonitis: A case report

Area of Science:

• Neurology
• Immunology
• Neuroimmunology

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease targeting the central nervous system.
• It is characterized by inflammation and demyelination, primarily affecting the optic nerves and spinal cord.
• Anti-aquaporin-4 antibodies (AQP4-IgG) are key biomarkers for NMOSD.

Observation:

• An 18-year-old male presented with symptoms suggestive of transverse myelitis, including neck pain and leg paresis.
• Brain MRI was normal, but spinal MRI revealed T2 hyperintense lesions.
• The patient tested positive for AQP4-IgG, confirming the NMOSD diagnosis.

Findings:

• The patient experienced significant improvement with high-dose methylprednisolone and supplements.
• Plasmapheresis was administered due to the unavailability of eculizumab, leading to further improvement.
• This case presents an atypical demographic (young male) and clinical manifestation (transverse myelitis without optic neuritis) of NMOSD.

Implications:

• Early diagnosis and prompt treatment are crucial for managing NMOSD, even in atypical presentations.
• Combination therapy including steroids, supplements, and plasmapheresis can be effective when targeted therapies are unavailable.
• This case underscores the importance of considering NMOSD in young individuals presenting with myelopathy, regardless of typical demographic or clinical features.