Intravenous methylprednisolone and immunoadsorption plasmapheresis in a 13 week–pregnant woman with aquaporin 4 IgG–positive neuromyelitis optica spectrum disorder

Abstract

She was a 39–year–old female who was 13 weeks pregnant. Her chief complaints were a left oculomotor nerve palsy and nausea. Brain MRI revealed an abnormal intensity extending from the corpus callosum, right medial temporal lobe, and left mesencephalic pontine tegmentum. Her serum aquaporin 4 antibody was positive. Based on the clinical, MRI and laboratory findings, a diagnosis of aquaporin4 IgG–positive neuromyelitis optica spectrum disorder (NMOSD) was made. Intravenous methylprednisolone : (IVMP) was initiated ; however her condition did not improve significantly. We, therefore, performed immunoadsorption plasmapheresis (IAPP) repeatedly, and she recovered fully from her symptoms. She was prescribed prednisolone 10mg/day to prevent relapse. During these treatments, her condition remained stable and no adverse effects on her pregnancy and delivery were indicated. There have been no reports on evidence based treatment of NMOSD during pregnancy. Our case suggest that IVMP, IAPP and prednisone in NMOSD can be effective and safe in early second trimester.