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Postscript
Letter
Relapse of neuromyelitis optica associated with oral progestin
  1. Li-Min Li1,
  2. Chao Zhang1,
  3. Lin-Jie Zhang1,
  4. Hui-Yue Guo1,
  5. Chun-Sheng Yang1,
  6. Rui Zhang1,
  7. Yu-Jing Li1,
  8. Fu-Dong Shi1,2,
  9. Li Yang1
  1. 1 Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
  2. 2 Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Li Yang, Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China; yangli2001{at}tmu.edu.cn

https://doi.org/10.1136/jnnp-2017-316356

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    Introduction

    Neuromyelitis optica (NMO) is an autoimmune disease of the central nervous system (CNS) characterised by optic neuritis (ON) and severe myelitis. NMO is a sexually dimorphic disease, predominantly affecting women and is active throughout most of their childbearing years. Pregnancy and delivery might adversely affect the course of NMO1–3; in turn, NMO could affect the outcome of pregnancy.4 Further, immunological changes derived from high levels of oestrogen and progesterone during pregnancy might influence the outcomes of NMO. However, the effect of exogenous progesterone on NMO has not been reported. Here, we describe a female patient with NMO that relapsed after oral ingestion of progestin prescribed for her dysfunctional uterine bleeding.

    Case report

    A 41-year-old Chinese woman with a 14-year history of NMO (figure 1A, B) was admitted to the hospital on her fourth day of decreased visual acuity in the left eye in October 2016. Fourteen days before the present attack, she was treated with oral norethindrone for 9 days (10 mg/day for the first 3 days, 7.5 mg/day for the subsequent 3 days and 6.25 mg/day for the final 3 days) due to dysfunctional uterine bleeding. One day after withdrawal of norethindrone, vision deteriorated in her left eye. She had been taking azathioprine, 2 mg/kg/day, since the previous relapse in 2015. Neurological examination revealed poor binocular vision (uncorrected visual acuity of the left eye <20/400, but the right eye with hand movement acuity …

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