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Abstract

Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory autoimmune disorder of the central nervous system, with optic neuritis and transverse myelitis as its most common presentations. Although immunomodulatory treatment options for NMOSD have expanded, preventing reactivation of latent infections in patients can still be a therapeutic challenge. Our patient presented to the emergency department during an NMOSD pseudo-relapse with untreated latent tuberculosis (TB) and chronic hepatitis B and was briefly treated with high-dose IV methylprednisolone. After confirmation that neither hepatitis B nor TB had reactivated, the patient was discharged on isoniazid and entecavir. A month later she was started on inebilizumab for relapse prevention of NMOSD. This case report highlights the therapeutic complexities of managing NMOSD that requires immunosuppression in the setting of preventing reactivation of TB and hepatitis B.