Late Recurrence of Neuromyelitis Optica Spectrum Disorder Following Multiple COVID-19 Vaccinations After Nearly Four Decades of Clinical Stability: A Case Report

Abstract Background: Neuromyelitis Optica Spectrum Disorder (NMO) is a rare autoimmune inflammatory disease of the central nervous system characterized by recurrent episodes of optic neuritis, transverse myelitis, and other neurologic manifestations.

Case presentation

We report the case of a 75-year-old white woman with NMO who remained clinically stable for nearly four decades following her initial diagnosis in 1982. In 2021, after receiving multiple doses of the Moderna COVID-19 vaccine, she developed progressive neurologic symptoms including worsening lower extremity spasticity, visual decline, and intractable nausea. Evaluation confirmed recurrent disease activity, and she underwent treatment with IV corticosteroids, plasma exchange, and multiple pharmacologic therapies. Due to refractory lower extremity spasticity, she was subsequently treated with serial botulinum toxin injections, which provided transient symptomatic improvement.