Highlights
- •NMO is characterized by severe relapses of optic neuritis and transverse myelitis.
- •A 35 year old pregnant woman presented to us with her first NMO attack.
- •She was treated with IV steroids, PLEX, and rituximab during her pregnancy.
- •She delivered at term without any apparent teratogenic effects on the baby.
- •This case adds to the few existing reports of giving rituximab during pregnancy.
Abstract
Background
Aquaporin-4 IgG (AQ4-IgG)-neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune
inflammatory CNS disease that is predominantly characterized by severe relapses of
optic neuritis and longitudinally extensive transverse myelitis (LETM). Women are
disproportionately affected by AQ4-NMOSD, usually with disease onset occurring between
the ages of 35–45. This has significant implications during pregnancy, as disease
activity in NMOSD does not remit during gestation. The optimal treatment of NMOSD
during pregnancy has not been established.
Methods
Case report.
Results
A 35-year old woman, 10 weeks pregnant, presented with bilateral optic neuritis and
intractable hiccups. Workup revealed seropositive aquaporin-4 IgG. She was treated
with pulse intravenous methylprednisolone and plasma exchange. Because of high risk
for future relapse, Rituximab 1000 mg was given at weeks 15 and 17 of pregnancy. She
had no further relapses during pregnancy. She delivered her daughter at 39 weeks without
complication.
Conclusion
This case demonstrated a favorable outcome in administering rituximab for NMOSD with
disease onset during pregnancy. This description of therapy for disease onset during
pregnancy is novel, and adds to the few existing case reports of administering rituximab
during pregnancy.
Keywords
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Article info
Publication history
Published online: October 13, 2019
Accepted:
October 11,
2019
Received in revised form:
October 10,
2019
Received:
August 9,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
