Acute Myelitis, Recurrent Optic Neuritis, and Seizures Over 17 Years.

Chen Zhao,Lei Liu,Aijun Li,Dongsheng Fan,Jiawei Wang

doi:10.3389/fneur.2020.541146

Abstract

Recent discovery of several autoantibodies, such as aquaporin-4 immunoglobulin G antibodies (AQP4-IgG), myelin oligodendrocyte glycoprotein immunoglobulin G antibodies (MOG-IgG) and glial fibrillary acidic protein immunoglobulin G antibodies (GFAP-IgG), has greatly facilitated differential diagnosis of autoimmune disorders of the central nervous system. Here we report an interesting case with a history as long as 17 years. Only until she was tested positive for MOG-IgG that her diagnosis was revised from multiple sclerosis to MOG-associated disease (MOGAD). Our case illustrates the significance of screening autoantibodies in patients suspected of inflammatory autoimmune neurologic disorders. In addition, this case demonstrates how MOGAD manifests and develops in a patient over a decade.

Highlights

Specialty section: This article was submitted to Multiple Sclerosis and Neuroimmunology, a section of the journal Frontiers in Neurology
cerebrospinal fluid (CSF) samples were unavailable due to the patient’s refusal of a lumbar puncture. This patient was diagnosed with multiple sclerosis (MS), but absence of oligoclonal band (OCB) and lack of the typical Dawson fingers pattern has challenged the diagnosis. Her Asian ethnicity and frequent optic neuritis (ON) relapses raised the possibility of neuromyelitis optica spectrum disorders (NMOSD) [3]
Repetitive testing of AQP4-IgG was negative in serum, and her spinal cord lesion did not meet the diagnostic criteria for NMOSD without AQP4-IgG [3]

Summary

Introduction

Specialty section: This article was submitted to Multiple Sclerosis and Neuroimmunology, a section of the journal Frontiers in Neurology. Until she was tested positive for MOG-IgG that her diagnosis was revised from multiple sclerosis to MOG-associated disease (MOGAD). Our case illustrates the significance of screening autoantibodies in patients suspected of inflammatory autoimmune neurologic disorders. Brain MRI revealed periependymal white matter lesions (Figure 1C).

Results

Conclusion