# Navigating Complexity in Pediatric NMOSD: Unusual Symptoms and Adverse Reactions: A Case Report

## TL;DR

This case report describes a 14-year-old girl with pediatric NMOSD who experienced unusual symptoms and adverse reactions to treatment.

## Contribution

The paper presents a rare case of NMOSD with multisystemic inflammation and atypical responses to rituximab therapy.

## Key findings

- The patient had NMOSD with concurrent cryptogenic organizing pneumonia.
- Rituximab therapy led to a favorable outcome with a two-year relapse-free period.
- The case highlights unusual adverse reactions to rituximab in NMOSD patients.

## Abstract

Background and Clinical Significance: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating disorder of the central nervous system, characterized by the presence of aquaporin-4 (AQP4) antibodies and a high relapse rate. We provide information about the diagnosis, unusual symptoms, and treatment of a paediatric patient with NMOSD. Case Presentation: A 14-year-old girl was hospitalized for weakness and paraesthesia of the lower limbs (LL). The patient underwent detailed investigations and was diagnosed with NMOSD and cryptogenic organizing pneumonia. Initial treatment with methylprednisolone and prednisone yielded a favourable response. Therapy with mycophenolate was initiated. However, the patient experienced two more relapses, prompting the use of rituximab therapy with a favourable outcome and a two-year relapse-free follow-up period. Conclusions: Patients with NMOSD may have multisystemic inflammation, including organs outside the central nervous system. Our case report highlights a case of NMOSD, pulmonary involvement, and unusual adverse reactions to rituximab.