Patients with NMOSD coexisting with both sjogren’s syndrome and tuberculosis are very rare. There are no specific guidelines for the treatment of these patients especially during pregnancy. We report a case of AQP4 seropositive Nmosd associated with Sjogren syndrome and tuberculosis in a postpartum female and is treated with rituximab. In 2017 a 25 year female presented with quadriparesis and is diagnosed as AQP4 positive NMOSD. She is treated with I.V.methyl prednisolone. 1 year later she became pregnant and is asymptomatic during pregnancy and at 2 months postpartum she developed paraparesis. She is treated with i.v.methyl prednisolone and plasmapheresis and started on Azathioprine. At the same time she is diagnosed with Sjogren’s syndrome. In 2021 Azathioprine is changed to MMF in view of pancytopenia. In 2022 she developed pulmonary TB and used ATT for 6 months. She discontinued MMF at that time. After completing ATT she conceived for the second time, remained asymptomatic throughout pregnancy and at 3 months postpartum she again developed quadriparesis. She is treated with rituximab with significant improvement of symptoms. For treating relapsing NMOSD coexistent with Sjogren syndrome and tuberculosis in the postpartum period, rituximab may be a good choice.

Keywords:Neuromyelitis Optica Spectrum Disorder; Sjogren Syndrome; Tuberculosis; Rituximab