Unmasking and provoking severe disease activity in a patient with NMO spectrum disorder

This is the authors' abstract. We don't add key points for this paper.

Neuromyelitis optica (NMO) is often not considered in patients with brain lesions in the absence of longitudinally extensive spinal cord lesions. When first-line therapies for multiple sclerosis (MS) fail, treatment is often escalated to natalizumab. We present a case of fulminant NMO spectrum disorder (NMOSD) relapse shortly after initiation of natalizumab in a patient previously suspected of having MS. This patient's course was complicated because disease activity continued even after transitioning to rituximab and having undetectable B cells.