Aquaporin-4 (AQP-4) immunoglobulin g seropositive Neuromyelitis Optica: A review and case report

Abstract

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a relatively new terminology composed to encompass patients with    neuromyelitis optica (NMO) and related immunological conditions. The diagnosis of this condition requires a seropositive aquaporin-4 immunoglobulin G (AQP-4 IgG), the presence of at least one core clinical characteristic and the exclusion of alternative diagnoses. Very few cases have been reported in sub-Saharan Africa.

Objective: The aim of this article is to report a classical case of NMOSDwith AQP-4 IgG seropositivity and normal brain, cervical and  thoracic MRI findings.

Result: We report a 25-year-old Nigerian woman who presented with recurrent and alternating weakness, pain and numbness of all  limbs, associated with episodic painful left-sided tonic spasms and urinary incontinence. She had earlier had symptoms of recurrent,  episodic and alternating loss of vision in both eyes, associated with ocular pain. Examination findings revealed an intact mental status, no  cranial nerve deficit and no focal limb weakness. Right-sided deep tendon reflexes were exaggerated. Vital signs were within normal  limits. Brain MRI, Cervical spine MRI and Thoracic spine MRI all revealed normal findings. Serum aquaporin-4 IgG assay returned positive  with a titer of 1:32. She was commenced on high dose steroids and there was gradual improvement of symptoms.

Conclusion: These  findings confirmed the diagnosis of neuromyelitis optica spectrum disorder, and satisfies the diagnostic criteria published in 2015 by the  International Panel for NMO Diagnosis (IPND)