Riwanti Estiasari

Neuromyelitis Optic

A-26-year-old woman came to hospital due to excessive sleep since 1 month before admission. There were also intermittent fever and urinary incontinence. Her serum sodium level was low. The symptoms getting worse and her speech sometimes incoherent with hallucination and short term memory impairment. Serum AQP4 Ab was positive. She was diagnosed as NMOSD with AQP4 positive since 3 year ago with transverse myelitis as her first symptoms. She got methylprednisolone and plasmapheresis for her first attack continue with mycophenolate mofethyl for long term treatment. In the middle of treatment she experienced incoherent speech and personality changes. Lumbar puncture was performed and CSF showed PCR CMV positive. Mycophenolate mofethyl was withdrawal and she was given ganciclovir for her CMV. After 2 month she recover and can back to work normally. For current attack, we found no PCR CMV on her CSF and the IgM CMV also non reactive. We gave her methylprednisolone 500mg with plasmapheresis.

Vidyo