[Diagnostic challenge in a man with intractable hiccups and vomiting: a case of neuromyelitis optica spectrum disorder (NMOSD)].

Neuromyelitis optica is an inflammatory CNS syndrome that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). According to the new diagnostic criteria the term NMO is replaced by the term NMOSD and for the first time criteria allow diagnosis in patients who have not experienced clinical involvement of either optic nerves or spinal cord. Area postrema, the emetic reflex center, may be a selective target of the disease. We report a case of a 74-year-old man who presented with intractable hiccups and vomiting. He underwent medical and surgical evaluation but the neurological consultation was delayed one month because these symptoms are usually not appreciated as the possible initial manifestation of NMOSD. Missing diagnosis at this early stage leads to a delay in the treatment and a risk of more severe manifestations, such as transverse myelitis.