{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:44:18Z","timestamp":1777632258609,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunity Inflam &amp;amp; Disease"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune astrocytopathy characterized by inflammatory demyelinating lesions in the central nervous system. Area postrema syndrome (APS), marked by intractable nausea, vomiting, and hiccups, is a recognized but less common initial manifestation. Post\u2010infectious autoimmunity triggered by SARS\u2010CoV\u20102 has been increasingly associated with NMOSD pathogenesis; however, the clinical significance of direct viral neuroinvasion and its relationship to divergent patient outcomes remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report two female patients who developed isolated APS shortly after COVID\u201019 infection. Both patients underwent comprehensive neurological evaluation, including brain and spinal magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis with metagenomic next\u2010generation sequencing (mNGS), and serological testing for aquaporin\u20104 immunoglobulin G (AQP4\u2010IgG), myelin oligodendrocyte glycoprotein immunoglobulin G (MOG\u2010IgG), and glial fibrillary acidic protein immunoglobulin G (GFAP\u2010IgG) using cell\u2010based assays. Clinical outcomes were compared in the context of antibody serostatus and treatment strategies. A review of the relevant literature on post\u2010COVID NMOSD was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both patients presented with intractable vomiting and hiccups following SARS\u2010CoV\u20102 infection, and MRI demonstrated isolated T2\/FLAIR hyperintense lesions in the dorsal medulla consistent with area postrema involvement. SARS\u2010CoV\u20102 RNA sequences were detected in the CSF of both patients via mNGS, suggesting direct viral neuroinvasion or blood\u2013brain barrier compromise. Despite similar initial presentations, their outcomes diverged dramatically. Patient 1 was AQP4\u2010IgG negative, responded well to immunotherapy with intravenous immunoglobulin and corticosteroids followed by mycophenolate mofetil maintenance, and remained relapse\u2010free at 12\u2010month follow\u2010up with significant lesion regression on MRI. Patient 2 was AQP4\u2010IgG positive in both serum and CSF, and despite acute treatment, experienced a fatal relapse 6 months later with longitudinally extensive transverse myelitis while on low\u2010dose prednisone monotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Isolated APS may represent an important yet under\u2010recognized manifestation of post\u2010COVID\u201019 autoimmune neuroinflammation. Detection of SARS\u2010CoV\u20102 in CSF supports a role for direct viral neuroinvasion as a localized inflammatory stimulus. AQP4\u2010IgG serostatus serves as a critical prognostic determinant: seronegativity is associated with a benign, monophasic course, whereas seropositivity mandates prompt initiation of potent immunosuppressive therapy to prevent devastating relapses. Clinicians should maintain a high index of suspicion for NMOSD in patients with unexplained persistent vomiting following COVID\u201019, and perform urgent neuroimaging and antibody testing for early risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/iid3.70421","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T04:30:37Z","timestamp":1775536237000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post\u2010COVID\u201019 Area Postrema Syndrome With SARS\u2010CoV\u20102 in CSF: A Dual\u2010Case Report and Review of the Literature"],"prefix":"10.1002","volume":"14","author":[{"given":"Wan","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Radiology, Affiliated Hospital, People's Hospital of Wenshan Prefecture Kunming University of Science and Technology Wenshan 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