Neuromyelitis optica spectrum disorder-like presentation following semaglutide therapy: A case report

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments for obesity and type 2 diabetes. GLP-1 receptors are also expressed on astrocytes and in regions commonly affected by neuromyelitis optica spectrum disorder (NMOSD), suggesting that GLP-1 signaling could influence astrocyte function and potentially be associated with NMOSD attacks. Here, we report a case of a 29-year-old woman who developed seronegative NMOSD coinciding with the use of the GLP-1RA semaglutide (Ozempic) for weight loss. The patient initially presented with gastroenteritis-like symptoms, followed by severe flaccid, areflexic quadriparesis. An extensive diagnostic workup, including lumbar puncture and Magnetic Resonance Imaging (MRI) scans, confirmed the NMOSD diagnosis.

We propose two potential mechanisms for this association. The first hypothesis suggests that semaglutide-induced alterations in the gut microbiome may trigger the activation of proinflammatory cytokines and dysregulate immune homeostasis, contributing to the development of NMOSD. The second hypothesis posits a direct effect of GLP-1RAs on GLP-1 receptors expressed on astrocytes and in central nervous system regions commonly affected by NMOSD. Although this case does not establish a definitive causal relationship, it underscores the need for further research to elucidate the underlying mechanisms and ensure the safe use of GLP-1RAs in patients at risk for autoimmune conditions.