Short communicationSuspected bacterial meningomyelitis: The first presenting clinical feature of neuromyelitis optica spectrum disorder

•Patient presents with suspected bacterial meningomyelitis•CSF and blood tests for bacteria, fungi, tuberculosis, antinuclear antibody all negative•MRI revealed several vertebral transverse and area postrema lesions.•Test for serum anti-aquaporin-4 antibody is positive.•Diagnosis may support hypothesis that pathogenesis of NMO triggered by infection.

A rare case of neuromyelitis optica spectrum disorder, suspected to be bacterial meningomyelitis as the initial manifestation, is reported. The patient presented with initial symptoms of meningomyelitis and fever. Cerebrospinal fluid analysis revealed pleocytosis (1280 × 106/L [98% lymphocytes]) and glucose level of 1.8 mmol/L. Magnetic resonance imaging revealed > 3 vertebral, longitudinally extensive transverse myelitis and area postrema lesions. Right optic neuritis was experienced 20 months after the first attack. Serum anti-aquaporin-4 antibody was positive, and a diagnosis of neuromyelitis optica spectrum disorder was made, supporting the hypothesis that the pathogenesis of neuromyelitis optica is triggered by infection.