Relapsing neuromyelitis optica in an adolescent girl.

Abstract

Early differentiation of neuromyelitis optica spectrum disorder (NMO-SD) from multiple sclerosis (MS) is of paramount importance as NMO-SD (especially relapsing variant) has more severe morbidity than MS. We describe a case of an adolescent girl who presented with repeated episodes of optic neuritis over a period of 4 years with normal brain MRI scans. She was treated initially as relapsing remitting MS, before showing clinical evidence of transverse myelitis (TM), and eventually being diagnosed as NMO-SD. Pulse intravenous methyl prednisolone along with immunosuppressive therapy led to remission of her disease. However, delay in diagnosis as NMO-SD led to visual disability in the left eye. Therefore, in young patients with recurrent optic neuritis and normal brain MRI, it may be prudent to get spinal MRI done to look for TM, even when asymptomatic. In addition, we should keep a low threshold for requesting aquaporin-4 antibody testing in these patients.

• Authors: Vinita Gupta, Saurabh Luthra, Shrey Maheshwari, Shrutanjoy M Das
• Journal: BMJ case reports (BMJ Case Rep) Vol. 14 Issue 8 (Aug 23 2021) ISSN: 1757-790X [Electronic] England
• PMID: 34426420 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adolescent
• Female
• Humans
• Magnetic Resonance Imaging
• Myelitis, Transverse
• Neoplasm Recurrence, Local
• Neuromyelitis Optica (diagnosis, drug therapy)
• Optic Neuritis (diagnosis, drug therapy)