A fatal disease hidden behind a common symptom: Neuromyelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disorder of the central nervous system. Recently, a number of clinical features have been identified in the diagnosis, and this disorder has been expanded to include a wider spectrum. It is important to have knowledge of these syndromes to diagnose this condition. One such presentation is intractable vomiting and hiccoughs, which is categorized as area postrema syndrome (APS) and is often misdiagnosed as a digestive disorder. We present a case of young female presenting with unresolving vomiting and hiccoughs. Magnetic resonance imaging done showed lesions in the dorsal medulla, suggestive of APS. A positive immunoglobulin G aquaporin-4 antibody confirmed the diagnosis of NMOSD. With this case report, we try to reiterate the importance of knowing the varied presentations of NMOSD and vigilance in identifying that a common symptom such as vomiting/hiccough can be due to an uncommon disorder.