Asian Journal of Case Reports in Medicine and Health

A girl in her teens presented with decreased sensation in the right half of the face and right half of the tongue associated with dysphagia, vomiting, and aphasia for 2 weeks with sudden onset flaccid quadriparesis for 7 days with diminished vision in both eyes and double vision for 5 days, with no history of fever, convulsions, diarrhoea, headache, palpitations, shortness of breath, loss of consciousness or features suggestive of bladder and bowel involvement with no history of trauma or similar episodes in the past.

MRI Brain revealed features favouring a demyelinating condition. MRI Spine, autoimmune encephalitis panel, ANA profile, and VEP were normal. NMOSD Screen (IIFD-EUROIMMUN) MOG & AQP-4 analysis showed a positive titre of Anti-NMO antibodies. She was treated with intravenous Methylprednisolone, oral prednisolone, and mycophenolate mofetil with 5 rounds of plasmapheresis. In subsequent follow-up, there was an improvement in power and gait with an improvement in vision.

A patient presenting with optic neuritis usually has a differential diagnosis of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD). MS, the commonest entity, should be ruled out first. The other two diagnoses have less favourable prognosis and the clinician should be vigilant about the possibilities, complications, and different treatment modalities. NMOSD can present without ocular symptoms and this significantly expands the presentation and differential of NMOSD when the patient does not have ocular involvement.