Myelin Oligodendrocyte Glycoprotein Antibody- Associated Disease Presenting with ADEM-Like Encephalomyelitis: A Case Report and Current Literature Review

Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease has recently been found to be a different nosological entity, with some clinical features overlapping with neuromyelitis optica spectrum disorders. We hereby describe the case of a patient who was first admitted in 2015 with a tingling sensation in both legs, severe lumbar pain, and gait problems, and later developed urinary retention, confusion, and seizure. Brain magnetic resonance imaging (MRI) showed multiple fluid attenuated inversion recovery hyperintense lesions with no gadolinium enhancement in the bilateral subcortical white matter, cerebellar peduncles, and cervical cord. Cerebrospinal fluid analysis demonstrated marked pleocytosis (116 cells/μL) and an elevated protein concentration (68 mg/dL). Neither oligoclonal bands nor the elevation of IgG index levels were detected (IgG index: 0.59). During the follow-up, he had 2 optic neuritis attacks in 4 years. Five years later, the patient was referred to our hospital with severe pain in both legs. Spinal MRI showed a longitudinally extending conus medullaris lesion with gadolinium enhancement. The patient showed full recovery after 7 days of 1000 mg/day IV methylprednisolone treatment, and the follow-up MRI showed no residual lesions. The anti-MOG IgG was found to be positive. In this case report, we would like to highlight the importance of MOG antibody testing in encephalitis.

Keywords

• anti-mog
• demyelinating disease
• adem
• optic neuritis
• transverse myelitis