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Ringelstein, M.; Harmel, J.; Distelmaier, F.; Ingwersen, J.; Menge, T.; Hellwig, K.; Kieseier, B.; Mayatepek, E.; Hartung, H.-P.; Kümpfel, Tania; Aktas, O. (October 2013): Neuromyelitis optica and pregnancy during therapeutic B cell depletion: infant exposure to anti-AQP4 antibody and prevention of rebound relapses with low-dose rituximab postpartum. In: Multiple Sclerosis Journal, Vol. 19, No. 11: pp. 1544-1547


Neuromyelitis optica (NMO) predominantly affects women, some in childbearing age, and requires early therapeutic intervention to prevent disabling relapses. We report an anti-AQP4 antibody-seropositive patient who became pregnant seven months after low-dose (100 mg) rituximab application. Pregnancy showed no complications, and low-dose rituximab restarted two days after delivery resulted in neurological stability for 24 months. Remarkably, her otherwise healthy newborn presented with anti-AQP4 antibody and reduced B lymphocyte counts in umbilical cord blood, which normalized three months later. Confirming and extending previous reports, our case suggests that low-dose rituximab might be compatible with pregnancy and prevent rebound NMO disease activity postpartum.