Riwanti Estiasari

NMOSD without AQP4

A-42-year-old male came with a primary complaint of slowly progressing blurry vision in his right eye 3 weeks ago. He described that as a black spot that gradually enlarges and blocks his peripheral vision. He also complained about having headaches and dizziness from four months ago. He was previously diagnosed with nutritional optic neuropathy. He admitted to having a drinking habit since 25 years ago.
On physical examination, his vitals were within normal limits. A relative afferent pupillary defect was noted on the right eye. A campimeter visual field test revealed inferior altitudinal hemianopia of the right eye. The right eye showed obscured optic disc border with hyperemic papil on funduscopy. The motor, sensory, and autonomic nervous system examinations were normal except for a positive bilateral Hofman sign.
The Visual Evoked Potential (VEP) was consistent with right optic nerve demyelination. The CSF analysis showed inflammatory CSF. The brain MRI showed focal thinning in the posterior aspect of the right optic nerve (FIESTA sequence). Spine MRI showed spinal cord hyperintensity on the level of C2–C6 (T2WI). The serum aquaporin 4 IgG and anti-MOG results were negative. The ANA IF examination showed a speckled pattern with 1:100 titer. This patient is diagnosed with aquaporin-4 negative NMO.

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