Anti-myelin oligodendrocyte glycoprotein antibodies in an Egyptian boy with recurrent paraplegia

Abstract

Abstract We report a case of NMOSD anti-MOG demyelinating disorder in a 5-year-old male. Case presentation A previously healthy 5-year-old male presented due to secondary inability to walk and incontinence. Initial neuroimaging identified demyelinating lesions of both corona radiata and centrum semiovale with intramedullary abnormal signal intensity opposite C5 and a long segment at upper dorsal spinal cord extending from D2 to D4. The patient received oral steroid with complete resolution of his symptoms. 2 years later, the patient presented with quadriparesis and incontinence. MRI brain and cervical spine revealed multiple cerebral demyelinating lesions and intramedullary high signal intensity opposite most of cervical spinal cord. After a course of oral steroid, the patient showed complete resolution of his symptoms except for mild right-hand weakness. CBC, ESR, ANA were normal. Aquaporin- 4 was negative. VEP showed mild bilateral optic nerve affection. CSF revealed no cells with no abnormal oligoclonal bands, but high IgG index was detected. As a result, IV methyl-prednisolone was initiated. Four months later, the patient presented with sudden diminution of vision. MRI brain showed bilateral symmetrical occipital T2 hyperintense signal. Anti-MOG antibody evaluation was positive. The patient received IV methyl-prednisolone and was commenced on mycophenolate mofetil. He showed complete clinical remission with no relapses. Conclusions This case outlines the management of anti-MOG demyelinating disorder. Understanding the presentation of this clinical entity may allow for earlier intervention and diagnosis with concomitant reduction of morbidity.