title: Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male.
abstract: Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Badri
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Teleb
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Saad
authors.initials: S
authors.lastname: Syed
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Miraie
authors.initials: M
authors.lastname: Wardi
authors.affiliation: Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Mateo
authors.initials: M
authors.lastname: Porres-Aguilar
authors.affiliation: Departments of Neurology, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA.
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
keywords: Aquaporin-4 antibodies; Devic syndrome; Neuromyelitis optica; Recurrent optic neuritis