Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica Spectrum Disorder
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2025-04
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Journal of Indian Medical Association
Abstract
A 17-year-old male patient presented with frequent hiccups, nausea, and vomiting. He was initially treated for a hiatus hernia and gastritis with partial relief; however, symptoms recurred and worsened, necessitating a thorough assessment that included upper gastrointestinal endoscopy. Neuroimaging was ordered to look for a central cause of vomiting. The results showed a demyelinating lesion in the area postrema (AP), indicating neuromyelitis optica spectrum disorder (NMOSD). It typically affects the optic nerves and causes inflammatory demyelination of the spinal cord. Anti-aquaporin 4 (AQP4) autoantibodies in cerebrospinal fluid (CSF) were positive and validated the diagnosis. Intravenous methylprednisolone, intravenous immunoglobulin (IVIg), and rituximab were administered, and the patient responded well to the treatment. Regular follow-up and adherence to treatment guidelines are crucial for optimal patient outcomes.
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Sarna MK, Setia M, Rijhwani P, Parakh R, Goyal G.. Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica Spectrum Disorder. Journal of the Association of Physicians of India. 2025 Apr; 73(4): 93-96