Abstract
Here we report three cases of anti-myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD) mimicking multiple sclerosis in which seropositivity for anti-MOG antibodies occurred during disease-modifying drug dimethyl fumarate (DMF) treatment. These patients developed relapses with anti-MOG antibody seroconversion after switching from fingolimod or steroid pulse therapy to DMF, which was associated with peripheral lymphocyte recovery. MOGAD is considered a humoral immune disease, and DMF reportedly enhances Th2-skewed humoral immune activity. Therefore, we suggest that DMF, but not fingolimod, may exacerbate humoral immune imbalance and enhance autoantibody production, leading to aggravation of MOGAD.
Highlights
Anti-myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD), which makes up ∼40% of anti-aquaporin 4 (AQP4) antibody–negative neuromyelitis optica spectrum disorders, is often difficult to distinguish from multiple sclerosis (MS) [1]
A recent report mentioned that dimethyl fumarate (DMF) is ineffective but not harmful in a patient with MOGAD [8], the effectiveness of DMF has yet to be determined
Our patients were diagnosed with atypical MS because they were seronegative for specific antibodies and had good response to IVMP and fingolimod
Summary
Anti-myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD), which makes up ∼40% of anti-aquaporin 4 (AQP4) antibody–negative neuromyelitis optica spectrum disorders, is often difficult to distinguish from multiple sclerosis (MS) [1]. The first patient was a 27-year-old woman who experienced two attacks of optic neuritis and transverse myelitis with short cervical and thoracic cord lesions in 4 years (Figure 1A). Cerebrospinal fluid (CSF) analysis revealed a slight elevation in protein levels and increases in myelin basic protein (MBP) levels and IgG index, but not in cell count or oligoclonal bands (Table 1; Patient 1, pre). She developed a severe relapse of transverse myelitis with a short cervical cord lesion accompanied by recovery from lymphocytopenia (Figure 1A).
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