Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica Spectrum Disorder

A 17-year-old male patient presented with frequent hiccups, nausea, and vomiting. He was initially treated for a hiatus hernia and gastritis with partial relief; however, symptoms recurred and worsened, necessitating a thorough assessment that included upper gastrointestinal endoscopy. Neuroimaging was ordered to look for a central cause of vomiting. The results showed a demyelinating lesion in the area postrema (AP), indicating neuromyelitis optica spectrum disorder (NMOSD). It typically affects the optic nerves and causes inflammatory demyelination of the spinal cord. Anti-aquaporin 4 (AQP4) autoantibodies in cerebrospinal fluid (CSF) were positive and validated the diagnosis. Intravenous methylprednisolone, intravenous immunoglobulin (IVIg), and rituximab were administered, and the patient responded well to the treatment. Regular follow-up and adherence to treatment guidelines are crucial for optimal patient outcomes.