Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) is a newly identified autoimmune demyelinating disorder that is often associated with acute disseminated encephalomyelitis and usually occurs postinfection or postvaccination. Here we report a case of MOGAD after mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. A previously healthy 68-year-old woman presented to our department with gradually worsening numbness on the right side of her face, which began 14 days after her second dose of an mRNA-1273 vaccination. The patient's brain MRI revealed a right cerebellar peduncle lesion with gadolinium enhancement, a typical finding of MOGAD. A neurological examination revealed paresthesia on her right V2 and V3 areas. Other neurological examinations were unremarkable. Laboratory workups were positive for serum MOG-IgG as assessed by live cell-based assays and the presence of oligoclonal bands in the cerebrospinal fluid (CSF). The patient's serum test results for cytoplasmic-antineutrophil cytoplasmic antibodies, perinuclear-cytoplasmic-antineutrophil cytoplasmic antibodies, GQ1b-antibodies, and aquaporin-4 antibodies (AQP4-IgG) were all negative. Tests for soluble interleukin (IL)-2 receptors in the serum, IL-6 in the CSF and skin pricks, and angiotensin converting enzyme tests were all unremarkable. The patient was diagnosed with MOGAD after receiving an mRNA SARS-CoV-2 vaccination. After two courses of intravenous methylprednisolone treatment, the patient's symptoms improved and her cerebellar peduncle lesion shrunk slightly without gadolinium enhancement. To date, there have only been two cases of monophasic MOGAD following SARS-CoV-2 vaccination, including both the ChAdOx1 nCOV-19 and mRNA-1273 vaccines, and the prognosis is generally similar to other typical MOGAD cases. Although the appearance of MOG antibodies is relatively rare in post-COVID-19–vaccine demyelinating diseases, MOGAD should be considered in patients with central nervous system (CNS) demyelinating diseases after receiving a SARS-CoV-2 vaccine.
Highlights
The emergence in December 2019 of a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has had devastating global consequences
We demonstrated a case of brainstem and cerebellar peduncle encephalitis with Myelin oligodendrocyte glycoprotein (MOG) antibodies developed after the patient’s SARS-CoV-2 vaccination
We showed that middle cerebellar peduncle lesions are typical features of MOGAD, and the lesion seen in the present case made a probable diagnosis of MOGAD [8]
Summary
The emergence in December 2019 of a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has had devastating global consequences. There have been 15 cases of ADEM and acute hemorrhagic leukoencephalitis (AHLE) after COVID-19 infections occurring mainly in adults Of these 15 cases, there has only been 1 pediatric case involving a 13-month-old female patient with an MOG antibody [6]. The patient’s lumbar puncture revealed no pleocytosis or elevated proteins but did reveal positive oligoclonal bands Her serum test results for the cytoplasmic-antineutrophil cytoplasmic antibody, perinuclear-cytoplasmic-antineutrophil cytoplasmic antibody, GQ1b-antibody, and aquaporin-4 IgG (AQP4-IgG) antibody were all negative. The patient did not experience any relapse during the subsequent 6-month period without any treatment Her MOG-IgG status in 6 months followup was positive for anti-IgG-Fc (1:128), but negative for IgG1 as secondary antibody. We were able to discover cases of MOGAD following COVID-19 vaccination by utilizing a PubMed search for terms including “COVID-19,” “vaccination,” and “myelin oligodendrocyte glycoprotein.”. We were able to discover cases of MOGAD following COVID-19 vaccination by utilizing a PubMed search for terms including “COVID-19,” “vaccination,” and “myelin oligodendrocyte glycoprotein.” We searched “COVID-19,” “vaccination,” and “neuromyelitis optica spectrum disorder” in order to ensure we had found all the documented cases of MOGAD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
