A diagnostic challenge in a young woman with intractable hiccups and vomiting: a case of neuromyelitis optica.
Intractable nausea and vomiting along with hiccups is a commonly encountered problem on any general medicine or gastroenterology service. These symptoms are usually not appreciated as the possible initial manifestation of neuromyelitis optica (NMO). Missing diagnosis at this early stage will lead to a delay in the treatment, and hence, irreversible complications including blindness and paraplegia could occur. We report a case of a 22-year-old young female who presented with intractable hiccups and vomiting. After extensive evaluation, she was found to have NMO which involved the area postrema, the vomiting center of the brain. Early diagnosis from the clinical picture aided by aquaporin-4 serologic testing is extremely important to allow early initiation of immunosuppressive therapy. Immunosuppression gives an opportunity to modify the disease at an earlier stage rather than waiting for evolution of disease to fulfill the diagnostic criteria of NMO.
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA; rohan86m@gmail.com.
Rohan
R
Mandaliya
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
Margot
M
Boigon
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
David G
DG
Smith
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
Suchit
S
Bhutani
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
Naveed
N
Ali
Division of Internal Medicine, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
Cheryl
C
Hilton
Division of Infectious disease, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
John
J
Kelly
Division of Neurology, Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
Nataliya
N
Ternopolska
aquaporin-4 antibody; area postrema; hiccups; neuromyelitis optica; vomiting