Post herpes zoster infection neuromyelitis optica spectrum disorder

Neuromyelitis optica is a severe autoimmune demyelinating disease; however, the trigger for autoimmunity in an individual patient is unclear. Here, we report the case of a 48 year old female presenting with longitudinally extensive transverse myelitis in the cervical region of the spinal cord two weeks post herpes zoster infection in right C6 dermatome. Though post herpetic myelitis was provisionally diagnosed, serological evaluation revealed aquaporin-4 antibody positivity, confirming the diagnosis of neuromyelitis optica spectrum disorder. Herpes zoster infection appears to have triggered the onset of autoimmunity, leading to the development of neuromyelitis optica spectrum disorder in this patient. •Neuromyelitis optica is a severe autoimmune demyelinating disease of idiopathic etiology postulated to be triggered by viral infections.•A 48 year old female presented with LETM of cervical spinal cord post herpes zoster infection and was provisionally diagnosed with post herpetic myelitis.•Aquaporin-4 antibody was positive, leading to diagnosis of neuromyelitis optica spectrum disorder.