Rare Case of NMOSD With Peripheral Nerve Damage Reported

Researchers from China reported the rare case of a patient with neuromyelitis optica spectrum disorder (NMOSD) with peripheral nerve damage, in a preliminary report that appeared in Research Square. 

“The neurologist should be aware of the unusual association between NMOSD and immune-mediated peripheral neuropathy,” the authors of the report wrote. They added that undifferentiated connective tissue disease and nerve damage caused by multiple antibodies may have together caused peripheral nerve damage in this particular case.

Read more about the diagnosis of NMOSD

Reports of NMOSD associated with peripheral nerve damage are rare. Here, researchers from Guizhou Provincial People’s Hospital in China reported the case of a 57-year-old female who presented to the hospital with nausea and vomiting that lasted more than 4 months, numbness in the arms and legs that lasted more than 3 days, and blurred vision for 1 day.

The patient was diagnosed with aquaporin-4 (AQP4) IgG-positive NMOSD. 

She also had undifferentiated connective tissue disease and multiple peripheral neuropathy. Additionally, she was positive for multiple antiganglioside antibodies and antisulfatide IgG antibodies in her serum and cerebrospinal fluid. 

She was treated with methylprednisolone, gamma globulin, plasma exchange, and rituximab, which led to an improvement in her condition. She was then discharged from the hospital.

“This is the first case report of NMOSD with peripheral neuropathy coexisting with undifferentiated connective tissue disease, which had also tested positive for multiple anti-ganglioside antibodies and anti-sulfatide IgG antibodies,” the researchers concluded.

“An immunologic derangement condition caused by undifferentiated connective tissue disease and multiple antibody-mediated neurological insults may have jointly contributed to her peripheral damage,” they added.

NMOSD is a demyelinating autoimmune disease of the central nervous system. It is characterized by recurrent attacks of optic nerve and spinal cord damage leading to visual impairment and disability. 

Reference

Li Y, Tang M, Yu L, et al. Anti-ganglioside antibody positive neuromyelitis optica spectrum disease with peripheral neuropathy: a case report. Res Sq. Posted February 1, 2023. doi:10.21203/rs.3.rs-2486609/v1