The differential for this patient’s initial presentation was most concerning for an infectious process and other high considerations on the differential included a parainfectious/post infectious inflammatory demyelinating entity such as MOGAD-ADEM, ADEM, pediatric onset Multiple Sclerosis (MS), or an inflammatory astrocytopathy like NMOSD-AQP4 + . This evidence concerns the gene AQP4 and myeloid sarcoma.