Neuromyelitis optica: A masquerader of multiple sclerosis
The present case has been published in the Indian Journal of Clinical and Experimental Ophthalmology.

An 18 year old female presented with history of fever since one week, weakness of lower limbs since 5 days, sudden, profound, painless diminished vision in LE since 2 days. She was diagnosed to have Acute Demyelinating Encephalomyelitis (ADEM) and was on treatment with steroid, T. Prednisolone 60mg OD initially with tapering dose and immunosuppressant T. Azathioprine 50mg BD.

On presentation BCVA OD was 6/6 with rest of the anterior segment being unremarkable. BCVA OS was PL present, PR inaccurate in nasal quadrant. Stereoscopic dilated fundus examination was normal in the right eye. Temporal pallor of the disc present in the left eye with rest of the fundus being normal. MRI brain showed mild focal cerebral edema in bilateral frontal regions with effacement of sulcal spaces and hyperintense lesions in right occipital lobe.

MRI spinal cord showed multiple short segment intrameduallary plaques between C2–C7 segments. She gave prior history of recurrent episodes of fever, headache, difficulty in voiding urine, weakness & diminished sensation over lower limbs with episodes of seizure. MRI done at that time, one year ago showed hyperintense lesions in right peritrigonal, body of corpus callosum on right side and left middle cerebellar peduncle, multiple short segment intramedullary plaques in cervical spinal cord with no cord expansion.

Antibodies to aquaporin-4 was done which was negative. For the present episode, she was started on immunoglobulins and physiotherapy with symptomatic improvement. Treatment with Inj. methyl prednisolone (1gram IV OD /day for 3 days ) followed by oral tablet prednisolone 60mg was initiated along with anticonvulsant, T. Levetiracetam 500mg BD and immunosuppressant T.Azathioprine 50mg BD. Vision improved to 6/18 at the end of treatment.

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