Abstract
Myelin Oligodendrocyte Glycoprotein (MOG) autoimmunity has recently emerged as an entity distinct from its clinical brother, Neuromyelitis optica (NMO) and its associated spectrum disorders (NMOSD). While these present in the same vein of transverse myelitis and optic neuritis, they differ in pathogenesis and biomarker positivity, with implications on treatment. This is the first known reported case of MOG positivity in the Philippines. A 25-year old Filipino female developed blurring of vision on the right with spontaneous resolution after three days. Three years later, she presented with numbness of the left arm and trunk, with T1 sensory level. Non-contrast cranial MRI showed T2-FLAIR hyperintense lesion on the left corona radiata. Spine MRI showed T2 hyperintensity from C3 to C4. Ophthalmologic evaluation confirmed bilateral optic neuritis. Pulse steroid therapy provided resolution of symptoms, with resolution of MRI lesions on repeat study after eight months. Symptoms recurred one month after, with triparesis after two months, in spite of oral steroids and Azathioprine. Patient was referred to our institution, and repeat MRI showed enhancing intramedullary lesions from C2 to C5 level. She was seronegative for aquaporin-4 assay. Spinal fluid studies revealed normal protein and IgG, with negative oligoclonal bands. Serum antibodies to MOG were detected. Therapy with Rituximab was given on the fourth and fifth months after disease recurrence, and has been relapse free with EDSS score of 1. NMOSD patients will benefit from MOG antibody testing where available, as this will have implications on treatment and prognosis.
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