{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:01:09Z","timestamp":1775804469524,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Aquaporin-4 antibodies (AQP4-Abs) are a key diagnostic biomarker of neuromyelitis optica spectrum disorder (NMOSD), and anti-Argonaute antibodies (AGO-Abs) have recently been reported in a range of autoimmune neurological conditions, although their clinical significance remains undetermined. In this report, we describe a 36-year-old woman who initially presented with sensory disturbances and mild vitamin B12 deficiency who was initially diagnosed with subacute combined degeneration. Vitamin supplementation partially improved her symptoms but her condition subsequently deteriorated, and she developed paraparesis, ascending sensory loss, and urinary incontinence. Magnetic resonance imaging revealed longitudinally extensive transverse myelitis with gadolinium enhancement. Serum and cerebrospinal fluid analyses were positive for AQP4-Abs and AGO-Abs, supporting the diagnosis of NMOSD with concomitant presence of AGO antibodies. Electrophysiological studies showed asymmetric axonal sensorimotor polyneuropathy, suggesting peripheral nervous system involvement contributing to early diagnostic uncertainty. The patient received immunotherapy including high-dose corticosteroids, intravenous immunoglobulin, and plasma exchange, after which marked neurological improvement was observed. Longitudinal multimodal assessments incorporating antibody titers, expanded disability status scale scores, somatosensory-evoked potentials, and neuroimaging were performed during follow-up. This case highlights the heterogeneous clinical presentation of NMOSD, the potential coexistence of AGO antibodies, and the possibility that serological changes may not parallel clinical recovery. Comprehensive antibody evaluation and multimodal monitoring may assist clinical decision-making in atypical neuroimmunological presentations.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1742459","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:05:53Z","timestamp":1775801153000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Neuromyelitis optica spectrum disorder associated with anti-argonaute antibodies presenting with subacute combined degeneration-like features"],"prefix":"10.3389","volume":"17","author":[{"given":"Fangyuan","family":"Yi","sequence":"first","affiliation":[{"name":"Department of Neurology, Jin Qiu Hospital of Liaoning Province (Geriatric Hospital of Liaoning Province)","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xunyu","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Chemistry and Chemical Engineering, Shenyang Normal University","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jin Qiu Hospital of Liaoning Province (Geriatric Hospital of Liaoning Province)","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.933415","article-title":"Sex bias in multiple sclerosis and neuromyelitis optica spectrum disorders: how it influences clinical course, MRI parameters and prognosis","volume":"13","author":"Nytrova","year":"2022","journal-title":"Front Immunol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.65.7.913","article-title":"Aquaporin-4 antibodies in neuromyelitis optica and longitudinally extensive transverse myelitis","volume":"65","author":"Waters","year":"2008","journal-title":"Arch Neurol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.molcel.2007.05.001","article-title":"Argonaute proteins: mediators of RNA silencing","volume":"26","author":"Peters","year":"2007","journal-title":"Mol Cell"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1006\/clin.1994.1179","article-title":"Characterization of the Su antigen, a macromolecular complex of 100\/102 and 200-kDa proteins recognized by autoantibodies in systemic rheumatic diseases","volume":"73","author":"Satoh","year":"1994","journal-title":"Clin Immunol Immunopathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00010.2016","article-title":"Autoantibodies to synaptic receptors and neuronal cell surface proteins in autoimmune diseases of the central nervous system","volume":"97","author":"Dalmau","year":"2017","journal-title":"Physiol Rev"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.84","article-title":"Autoantibodies in chronic inflammatory neuropathies: diagnostic and therapeutic implications","volume":"13","author":"Querol","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s00415-025-13331-6","article-title":"Case report: anti-argonaute antibodies in Epstein-Barr virus encephalitis","volume":"272","author":"Pan","year":"2025","journal-title":"J Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1006-2963.2021.06.002","article-title":"Guidelines for diagnosis and treatment of neuromyelitis spectrum diseases in China (2021)","volume":"28","year":"2021","journal-title":"Chin J Neuroimmunol Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11634-0","article-title":"Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). 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