Area postrema syndrome, characterized by nausea, emesis, and persistent hiccups can be the initial manifestation of demyelinating diseases of the central nervous system.

We report a 4-year-old girl who presented with intractable vomiting that was noted to have signs of demyelination in the area postrema. MRI of the spine revealed longitudinally extensive myelitis in the cervical and thoracic spine. Neuromyelitis optica spectrum disorder (NMOSD) was suspected. Serum anti-aquaporin 4 antibodies were positive. Oligoclonal bands in cerebrospinal fluid were negative.

NMOSDs are extremely rare in the pediatric population, this being the second case reported in Colombia. It is crucial to consider the possibility of such neurological disorders in the setting of intractable vomiting.