Rituximab (RTX) is a monoclonal antibody that targets CD20 on B cells and is used to reduce the relapse risk in neuromyelitis optica spectrum disorder (NMOSD). Some patients experience relapse or exacerbation shortly after RTX treatment. We report a 54-year-old female with seronegative NMOSD who relapsed soon after RTX treatment.

Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are common causes of optic neuritis, typically involving anti-aquaporin 4 (AQP4) and Myelin oligodendrocyte glycoprotein (MOG) antibodies. It is scarce for both AQP4 and MOG antibodies to be simultaneously positive. Although NMOSD and MOGAD share clinical features, they differ in symptoms, magnetic resonance imaging findings and outcomes. Both conditions are treated with steroids and immunoglobulins but exhibit distinct responses. We report a case of NMOSD which was double seropositive for AQP-4 and MOG antibodies.

Autonomic dysfunction occurs frequently in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Patients with either condition may present with autonomic symptoms such as bladder, sexual, cardiovascular, thermoregulatory, and gastrointestinal dysfunction, and fatigue, but autonomic symptoms that affect quality of life are underrecognized in clinical practice. The immunopathogenesis of MS has been considered to be associated with autonomic dysfunction. Applying appropriate treatment strategies for autonomic dysfunction is important to improve the quality of life of patients. Here we review autonomic dysfunction and how this is managed in patients with MS and NMOSD.

Citations

• Sexual function and related predictors in male with multiple sclerosis and neuromyelitis optica spectrum disorder: a case–control study
  Saeed Vaheb, Mohammad Yazdan Panah, Mohammad Mohammadi, Mohammad Amin Sadri, Narges Ebrahimi, Sarina Loghmani, Marjan Beigi, Vahid Shaygannejad, Omid Mirmosayyeb
  The Journal of Sexual Medicine.2025; 22(2): 274.     CrossRef