When gut and nerves collide: A case of Neuromyelitis Optica Spectrum disorder after golimumab for ulcerative colitis

Anti-TNF alpha agents, such as golimumab, are effective treatment options for moderate to severe inflammatory bowel disease. However, demyelinating syndromes have been reported as rare adverse events. We present the first documented case of Neuromyelitis Optica Spectrum Disorder with positive aquaporin-4 antibodies following golimumab therapy for ulcerative colitis, manifesting as intractable hiccups secondary to Area Postrema Syndrome. The patient was treated with plasmapheresis and rituximab, with partial improvement.