We present a case of a woman with systemic lupus erythematosus (SLE) who had refractory episodes of neuromyelitis optica spectrum disorder (NMOSD) and was successfully treated with rituximab. She was positive for anti-aquaporin-4 (AQP4) antibody and had typical cranial and longitudinally extended spinal lesions but no optic nerve involvement. There is no established treatment for NMOSD/SLE overlap cases. Our experience suggests that rituximab may be effective for patients with combined SLE and anti-AQP4 antibody-positive NMOSD.
WingerchukDMLennonVALucchinettiCFPittockSJWeinshenkerBG. The spectrum of neuromyelitis optica. Lancet Neurol2007; 6: 805–815.
2.
LennonVAKryzerTJPittockSJVerkmanASHinsonSR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med2005; 202: 473–477.
3.
KolfenbachJRHornerBJFerucciEDWestSG. Neuromyelitis optica spectrum disorder in patients with connective tissue disease and myelitis. Arthritis Care Res (Hoboken)2011; 63: 1203–1208.
4.
EtemadifarMSalariMMirmosayyebOet al.Efficacy and safety of rituximab in neuromyelitis optica: Review of evidence. J Res Med Sci2017; 22: 18–18.
5.
WingerchukDMLennonVAPittockSJLucchinettiCFWeinshenkerBG. Revised diagnostic criteria for neuromyelitis optica. Neurology2006; 66: 1485–1489.
6.
SirithoSApiwattanakulMNakashimaITakahashiTFujiharaKPrayoonwiwatN. Features of anti-aquaporin 4 antibody-seronegative Thai patients with neuromyelitis optica spectrum disorders: A comparison with seropositive cases. J Neurol Sci2014; 341: 17–21.
7.
PittockSJLennonVAde SezeJet al.Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol2008; 65: 78–83.
8.
NasirSKerrDABirnbaumJ. Nineteen episodes of recurrent myelitis in a woman with neuromyelitis optica and systemic lupus erythematosus. Arch Neurol2009; 66: 1160–1163.
