Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) initially presenting as septic meningoencephalitis in a 16-year-old male
  • Maria Elizabeth Karavassilis
    Department of Acute Medicine, Watford General Hospital, Watford, UK
  • Dmitriy Chernov
    Department of Acute Medicine, Watford General Hospital, Watford, UK
  • Sinda Dakhlia
    Department of Acute Medicine, Watford General Hospital, Watford, UK
  • Paramalingam Saravanan
    Department of Acute Medicine, Watford General Hospital, Watford, UK

Keywords

MOG antibody, meningoencephalitis, acute disseminated encephalomyelitis

Abstract

Background: We describe a case of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in a 16-year-old patient who initially presented with clinical features of septic meningoencephalitis. This case outlines the importance of considering a diagnosis of MOGAD in patients who fail to improve with appropriate antimicrobial therapy or show a positive clinical response to glucocorticoids (often used in treatment of meningococcal meningitis). We emphasise the importance of recognising that an infectious prodrome can precede MOGAD.
Case description: A 16-year-old male was admitted with vomiting, fever, headache, photophobia and altered mental state. He was treated for meningoencephalitis with initial clinical improvement. Lumbar puncture findings were suggestive of viral meningoencephalitis. During admission the patient went through several periods of transient clinical and biochemical improvement, alternating with periods of symptomatic relapse. On day 17 of admission, he was transferred to a tertiary centre for suspected autoimmune disseminated meningoencephalitis (ADEM) and two days later, he suffered a catastrophic neurological decline with new dysarthria, dysphagia, aphasia, horizontal nystagmus and facial paralysis. He made a remarkable neurological recovery after commencing treatment with IV immunoglobulin, IV methylprednisolone and plasma exchange, with complete resolution of symptoms.
Conclusion: MOGAD can run a variable course and present soon after a central nervous system infection, making the diagnosis more challenging. Nonetheless, patients can achieve a full neurological recovery with early recognition, diagnosis and treatment of this rare entity.

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References

  • Belman AL, Hertz D, Hanefeld F. Introduction: historical perspective of pediatric multiple sclerosis and related disorders. In: Chabas D, Waubant EL, editors. Demyelinating disorders of the central nervous system in childhood, New York: Cambridge University Press; 2011, p. 1–9.
  • Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S, et al. Acute disseminated encephalomyelitis: updates on an inflammatory CNS syndrome. Neurology 2016;87: S38–S45.
  • Tenembaum S, Chitnis T, Ness J, Hahn JS. International Pediatric MS Study Group. Acute disseminated encephalomyelitis. Neurology 2007;68:S23–S36.
  • Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S, et al. Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein. J. Neurol Neurosurg Psychiatry 2015;86:265–272.
  • Hor JY, Fujihara K. Epidemiology of myelin oligodendrocyte glycoprotein antibody-associated disease: a review of prevalence and incidence worldwide. Front Neurol 2023;14:1260358.
  • Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol 2023;22:268–282.
  • Jarius S, Pellkofer H, Siebert N, Korporal-Kuhnke M, Hümmert MW, Ringelstein M, et al. Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients. J Neuroinflammation. 2020;17:261.
  • Tumani H, Deisenhammer F, Giovannoni G, Gold R, Hartung HP, Hemmer B, et al. Revised McDonald criteria: the persisting importance of cerebrospinal fluid analysis. Ann Neurol 2011;70:520–521.
  • Wong YYM, van Pelt ED, Ketelslegers IA, Catsman-Berrevoets CE, Hintzen RQ, Neuteboom RF. Evolution of MRI abnormalities in paediatric acute disseminated encephalomyelitis. Eur J Paediatr Neurol 2017;21:300–304.
  • Honkaniemi J, Dastidar P, Kähärä V, Haapasalo H. Delayed MR imaging changes in acute disseminated encephalomyelitis. Am J Neuroradiol 2001;22:1117–1124.
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    Published: 2024-06-11
    Issue: 2024: Vol 11 No 7 (view)


    How to cite:
    1.
    Karavassilis ME, Chernov D, Dakhlia S, Saravanan P. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) initially presenting as septic meningoencephalitis in a 16-year-old male. EJCRIM 2024;11 doi:10.12890/2024_004596.