Satralizumab in the management of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder during pregnancy: a case report

We report the case of a 25-year-old pregnant woman who was diagnosed with aquaporin-4 antibody-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) at 19 weeks of gestation. During the acute stage of the disease, she was treated with high-dose prednisone pulse therapy. Beginning in the fourth week after disease onset, satralizumab was introduced as an adjunctive therapy, which enabled the progressive reduction and eventual discontinuation of corticosteroids. Subsequent follow-up showed marked improvement in visual field defect, successful spontaneous delivery, stable maternal condition, and transient early neonatal complications with favorable short-term recovery. This represents the first reported case in China of a patient diagnosed with AQP4 + NMOSD during pregnancy who was treated with satralizumab. This case provides additional clinical evidence to inform therapeutic decision-making for NMOSD occurring in pregnancy.