Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder Triggered by Herpes Zoster: A Case Report and Literature Review

We report the case of a 70-year-old female who developed acute transverse myelitis 1 month after herpes zoster infection and was diagnosed with aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder. The patient was treated with high-dose corticosteroid and intravenous immunoglobulin therapy and her serum AQP4 antibody seroconverted to negative 3 months later. This case suggests that varicella-zoster virus reactivation may trigger transient AQP4 autoimmunity and highlights the clinical significance of post-treatment seroreversion in distinguishing infection-triggered from idiopathic neuromyelitis optica spectrum disorder.