We present a pediatric case of neuromyelitis optica with barely noticeable initial alterations on neuroimaging. Asymptomatic and atypical pulmonary lesions were also detected, which can represent some novelty regarding the spectrum of manifestations of the disease. Subsequently, the patient exhibited more pronounced clinical and radiological symptoms and tested positive for serum anti-aquaporin-4 antibodies. Conservative treatment proved ineffective, and the disease progressed rapidly. Ultimately, the patient underwent successful allogeneic bone marrow transplantation. This case was challenging at first but ultimately proved to be a case of neuromyelitis optica spectrum disorder with multisystem involvement, an increasingly recognized condition.  Kulcsszavak: neuromyelitis optica spectrum disorder, multisystem involvement, area postrema, allogeneic bone marrow transplantation, NMOSD