We describe the clinical course of a patient with neuromyelitis optica spectrum disorder who showed reconversion (negative to positive) of AQP4-IgG upon clinical relapse after tapering prednisolone. Because of side effects, prednisolone could not be administered as maintenance therapy to prevent recurrence. Combination therapy with tacrolimus maintained the AQP4-IgG negative state while tapering the prednisolone. Prednisolone should be tapered carefully and the addition of an immunosuppressant should be considered.
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