Co-occurrence of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder and hepatocellular carcinoma: A case report

Neuromyelitis optica spectrum disorder is a rare, relapsing autoimmune disease in which the immune system attacks the central nervous system, primarily the optic nerves and spinal cord. It causes inflammation and demyelination in the central nervous system. A defining feature of neuromyelitis optica spectrum disorder is the presence of antibodies targeting aquaporin-4. Although rare, some documented case reports have linked neuromyelitis optica spectrum disorder to the development of certain cancers. Herein, we report a case of a 60-year-old female patient who presented with relapsing optic neuritis and longitudinally extensive transverse myelitis, with positive aquaporin-4 antibodies in the cerebrospinal fluid. The patient was treated with methylprednisolone and prednisone. She was later diagnosed with hepatocellular carcinoma. This represents the first case report of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder associated with hepatocellular carcinoma. In addition, this report contributes to the growing body of literature on paraneoplastic neuromyelitis optica spectrum disorder and highlights the need for comprehensive cancer screening, as this neurological syndrome may present with an underlying malignancy in older adults.