Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system that primarily affects young women and is associated with antibodies against aquaporin-4 (AQP4). Disease onset during pregnancy presents both diagnostic and therapeutic challenges, and there is an increased risk of relapse in the postpartum period, which can lead to a higher risk of long-term sequelae. We present the case of a 22-year-old pregnant woman who developed longitudinally extensive transverse myelitis during the second trimester as the first manifestation of NMOSD and experienced multiple neurological relapses during follow-up, resulting in optic nerve atrophy as a permanent sequela. This case highlights the complex interaction between autoimmune disease, pregnancy, immunosuppressive therapies, and access barriers to treatment, emphasizing the importance of a multidisciplinary approach and sustained therapeutic adherence to prevent disability progression.