Karine Beiruti, Saad Abu Saleh, Marcelo Daitzchman and Radi Shahien
A 66 year old woman suffering from recurrent attacks of neuropathic burning pain over the past 6 years, affecting first the sacral region and then progressively different locations on the face, was referred to our facility. She had severe paraparesis and signs of brainstem dysfunction leading to respiratory failures. After an extensive investigation including brain and spinal cord MRI and laboratory findings, such as positive test for aquaporin-4 immunoglobulin G antibodies (AQP4-IgG), the patient was found to suffer from neuromyelitis optica spectrum disorder (NMOSD) without optic neuritis. She was initially treated with corticosteroids followed by plasmapheresis. She partially recovered regarding her respiratory function but remained paraplegic. She was placed on azathioprine and died a few months afterwards.