NMOSD triggered by physicochemical exposures: A two-case report

• First NMOSD case linked to acute ocular organic solvent exposure • Mandibular trauma potentially triggered cervical myelitis in NMOSD • Both cases show anatomical concordance between trigger and symptom site • Reinforces physicochemical factors as potential NMOSD triggers The potential role of physicochemical environmental exposures in triggering neuromyelitis optica spectrum disorder (NMOSD) remains incompletely understood. This report describes two cases of aquaporin-4 (AQP4) antibody-positive NMOSD with onset potentially linked to specific physicochemical events. A 29-year-old male developed optic neuritis in his right eye immediately after occupational ocular exposure to organic solvents from paint remover. He subsequently experienced six relapses over five years. A 47-year-old female presented with cervical myelitis two days after sustaining minor mandibular trauma. In both cases, serological testing confirmed AQP4-immunoglobulin G antibodies. Notably, the initial neurological manifestations (optic neuritis, myelitis) corresponded anatomically to the sites of exposure (eye, face/jaw). These observations highlight a temporal and anatomical association between specific physicochemical exposures (organic solvents, mechanical trauma) and the onset of NMOSD in these susceptible individuals. While causality cannot be proven, the findings suggest that such factors may contribute to disease initiation in some patients, warranting further systematic investigation into environmental triggers in NMOSD pathogenesis.