2023 Volume 63 Issue 11 Pages 748-753
The patient was a 58-year-old Japanese man. At age 52 years, he was diagnosed with human immunodeficiency virus (HIV) infection and had been receiving highly active antiretroviral therapy (HAART). He presented to the emergency department with acute upper left and right lower extremity paralysis. Spinal cord magnetic resonance imaging showed intramedullary signal changes over three vertebral bodies in the cervical spinal cord. Anti-aquaporin-4 antibody was positive in serum, and neuromyelitis optica spectrum disorder (NMOSD) was diagnosed. Steroid pulse therapy and plasma exchange were performed but had limited effects. In Japan, there is no report of NMOSD after HIV infection treated with rituximab. Rituximab administration should be considered in refractory cases of NMOSD after HIV infection.
