Neuromyelitis Optica-Associated Acute Intermediate Uveitis

Optic neuritis is one of the diagnostic criteria for Neuromyelitis Optica Spectrum Disorder (NMOSD). However, the presentation of other ophthalmic manifestations in a patient with NMOSD is less common. A case of intermediate uveitis in a patient with anti-aquaporin-4 antibody (AQP4) positivity is detailed in this report. We present here a case of a 17-year-old Southeast Asian woman who presented with segmental fullness of the optic disc margin, small hypopigmented lesion along inferior temporal arcade, trace vitreous cells and inferior snowballs consistent with unilateral intermediate uveitis. The patient subsequently presented with an episode of optic neuritis of the same eye, resulting in diagnostic workup conforming NMOSD including neuroimaging and AQP4 antibody. Our case report highlights that NMOSD should be considered in the differential for intermediate uveitis. Furthermore, the sequence of both intermediate uveitis and optic neuritis in our patient demonstrates the importance of continued ophthalmic exams in patients with NMOSD.