Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating central nervous system disease commonly presenting with optic neuritis and transverse myelitis. Its pathology is mediated by serum aquaporin 4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG) antibodies. It can present in a relapsing and monophasic pattern and is diagnosed using the diagnostic criteria published in 2015 by the international panel on neuromyelitis optica (NMO) diagnosis. We describe the case of a 25-year-old man who had a history of painful eye movement and complete loss of vision affecting his left eye for which he was diagnosed with optic neuritis two months prior to presentation. The patient presented with transverse myelitis followed by a picture of autonomic dysfunction in the form of labile blood pressure and heart rate readings associated with profuse sweating as well as significant MRI findings. Neuromyelitis optica was diagnosed with positive AQP4-IgG and longitudinally extensive transverse myelitis. Treatment was initiated with pulse steroid and plasmapheresis followed by oral prednisolone and azathioprine following which the patient's condition stabilized.