Rapidly progressive neuromyelitis optica, report of a case

Abstract

Aims/Purpose: To describe a clinical case of rapidly sequential bilateral optic neuritis associated with positive serological antibodies against myelin oligodendrocyte glycoprotein (MOG) in a 54‐year‐old Moroccan woman, who present loss of visual acuity in her left eye (OS) of 1 week of evolution.Methods: In the ophthalmological examination, she presented a visual acuity (VA) of 4/10 in the right eye (RE) and counting fingers at 1 meter in OS, with an afferent pupillary defect in OS. The ocular fundus shows papilledema in OS, with bilateral retinal nerve fibre layer (RNFL) thickening by optical coherence tomography (OCT). Rest of exploration normal. A complete analytical study and magnetic resonance imaging (MRI) are requested. While waiting for results, she returned to the emergency room due to greater visual loss, showing VA of hand movement in OD and perception of light in OS. OCT showed increased RNFL thickening and fluorescein angiography showed papillary hyperfluorescence. The visual field revealed severe generalized depression in both eyes.Results: Brain and orbital MRI showed bilateral enhancement of the anterior optic nerves, with extension of enhancement to their intracranial portion, chiasm, and right optic tract. The analytical study showed a positive result for MOG antibodies with a titre of 1:80. We proceeded to intravenous treatment with methylprednisolone 1 gd/day for 5 days followed by oral corticosteroids and plasmapheresis. The patient presented a remarkable clinical improvement with VA improvement to 6/10 in both eyes, disappearance of optic nerve edema, and normalization of RNFL.Conclusions: The discovery of MOG‐Immunoglobulin G as a biomarker for inflammatory demyelinating diseases of the Central Nervous System other than Multiple Sclerosis represents a paradigm shift in the field of neuroimmunology. Myelin oligodendrocyte glycoprotein‐associated disorder has the potential to cause devastating long‐term visual impairment.