A Case Report of NMO Transverse Myelitis

Anna      Lafian; Tandis      Mahani; Mehrnaz      Hojjati; Taraneh      Sarlati

doi:10.2174/0115733971261420230919110103

Abstract

Background: Transverse myelitis is considered one of the cardinal features of neuromyelitis optica spectrum disorder (NMOSD), an immune-mediated inflammatory condition of the CNS characterized by severe, immune-mediated demyelination and axonal damage predominantly targeting optic nerves and spinal cord. We describe a case in which a diagnosis of NMOSD was established, associated with West Nile Virus (WNV) infection.

Case Presentation: A healthy 18-year-old female presented with intractable hiccups and rapidly progressing paraparesis. MRI demonstrated T2 edema extending from the medulla to the conus, consistent with longitudinally extensive transverse myelitis. Serum and CSF Aquaporin-4 IgG (AQP4) were both positive with high titers. In conjunction with antiviral therapy, immunomodulatory treatment was initiated using pulse methylprednisolone, plasmapheresis and Rituximab. A month and a half after admission, the patient was fully ambulatory with no residual symptoms. On her rheumatology follow-up visit, West Nile Virus-specific IgM in CSF was found to be positive from the patient’s initial presentation.

Conclusion: We propose that West Nile Virus may have been the autoimmune trigger to the patient’s development of NMOSD, highlighting the importance of evaluating viral triggers in autoimmune diseases.

Keywords: Transverse myelitis, West Nile Virus, NMOSD, CSF, immune-mediated demyelination, axonal damage.

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DOI https://dx.doi.org/10.2174/0115733971261420230919110103	Print ISSN 1573-3971
Publisher Name Bentham Science Publisher	Online ISSN 1875-6360

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