Neuromyelitis Optica Spectrum Disorders Coinciding with Systemic Autoimmune Diseases: a Case Report

Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory demyelinating diseasesaffecting the central nervous system (CNS) described by immune-mediated axonal damage to optic nerves and spinal cord. Previously, they were considered a multiple sclerosis variant, but based on unique immunologic pathophysiology, they are now recognized as an independent disease entity. The exact causes of NMOSD are unclear, but the role of anti-aquaporin-4 autoantibody( AQP4-Ab) in the pathogenesis of NMOSD has been indicated in previous studies. In recent years, there has been growing information of NMOSD association with other systemic autoimmune diseases, such as myasthenia gravis (MG), systemic lupus erythematosus (SLE), autoimmune thyroid diseases,and Sjögren’s syndrome bringing up ideas of shared autoimmune pathophysiology and genetic susceptibility. Recognizing these comorbidities is without a doubt necessary for appropriate treatment and prevention of neurologic and systemic complications over time. In this article, we describe a case of NMOSD presenting with concurrent myasthenia gravis. The patient was a young woman of about 30 years of age referred to Mashhad’s Ghaem hospital with a history of upper and lower extremity weakness, bilateral fatigable ptosis and blurred vision. Clinical features and para-clinical investigations indicated coexistence of NMOSD and myasthenia gravis. Conclusion: According to this studyand other reports, clinicians should carefully investigate atypical systemic or laboratory signs in all patients with NMOSD to rule out other related comorbidities because these comorbidities may affect the treatment plans and thus may improve the patients’ outcome.