From Transverse Myelitis to Optic Atrophy: An Unfavorable Clinical Course of AQP4-Positive Neuromyelitis Optica With Onset During Pregnancy and Multiple Relapses.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system that primarily affects young women and is associated with antibodies against aquaporin-4 (AQP4). Disease onset during pregnancy presents both diagnostic and therapeutic challenges, and there is an increased risk of relapse in the postpartum period, which can lead to a higher risk of long-term sequelae. We present the case of a 22-year-old pregnant woman who developed longitudinally extensive transverse myelitis during the second trimester as the first manifestation of NMOSD and experienced multiple neurological relapses during follow-up, resulting in optic nerve atrophy as a permanent sequela. This case highlights the complex interaction between autoimmune disease, pregnancy, immunosuppressive therapies, and access barriers to treatment, emphasizing the importance of a multidisciplinary approach and sustained therapeutic adherence to prevent disability progression.