To describe a case of previously undiagnosed latent neuromyelitis optic that was reactive by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Authors searched PubMed and Google Scholar for articles using the keywords: “COVID-19”, “SARS-CoV-2”, “Neuromyelitis Optic”, “NMO”, “Neuromyelitis Optic Spectrum Disorder”, “NMOSD”

49-year-old immunocompetent male with history of legal blindness secondary idiopathic meningitis and recent COVID-19 infection presents with a decline in visual acuity starting two weeks after initial COVID-19 symptoms.  

Ophthalmologic exam revealed retrobulbar optic neuritis. Serum evaluation was positive for Aquaporin-4-IgG at 1:10 titer using fluorescence-activated cell sorting assay.  MRI of spinal cord displayed hyperintense signal change as well as cord atrophy consistent with remote demyelinating lesion.

Roughly 30 years prior to presentation, patient was evaluated for headaches and intractable emesis. During an eight-month hospitalization he developed severe visual impairment and obstructive hydrocephalus status post ventriculoperitoneal shunt. He was treated with several antimicrobials, but an organism was never identified. Following the initial illness, he had no further progression or new impairment until current presentation. 

The rarity and heterogenous nature of NMO has made it difficult to diagnosis, but the advent of Aquaporin-4-IgG allows for easier identification. While diagnostic capabilities have risen, the exact cause of NMO remains unknown. Rare cases of infectious organisms linked to NMO have been reported, but our case highlights the first ever reported link between COVD-19 and reactivation of latent NMO.