Title : A Case of Myelin Oligodendrocyte Glycoprotein Antibody Disease Presenting Similar to Multiple Sclerosis
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is defined as an autoimmune disease of the CNS associated with a serological antibody against myelin oligodendrocyte glycoprotein (MOG). MOG is found within the CNS: the optic nerves, brain, and spinal cord (1). Clinically, the disease can resemble multiple sclerosis (MS) and neuromyelitis optica spectrum disorders noted by relapses of optic neuritis and transverse myelitis (1). We report a patient who was brought to clinic for a second opinion after being diagnosed with multiple sclerosis for many years with remitting and relapsing symptoms before experiencing complete paraplegia of the lower extremities and presenting with new symptoms inconsistent with multiple sclerosis and more concerning for MOGAD.
A woman in her early forties presented to clinic for a second opinion after being diagnosed with multiple sclerosis (MS) in 2004. Initial symptoms included left sided paresthesia following the birth of her first child. Her initial MRI showed spinal lesions and she began Aubagio for treatment. Her MS was characterized by multiple relapses with good recovery until August 2020. In August 2020 the patient experienced complete paraplegia and lost all sensation of the lower extremities with no since recovery. Her neurological exam was notable for both upper and lower motor neurons signs such as complete absent strength, movement, sensation, reflexes, and hypotonia in the lower extremities, but brisk reflexes bilaterally in the upper extremities. Most recent MRIs showed spinal cord lesions at C1-C3, T8, T12/L1 and heterogeneous patchy abnormal edema of the spinal cord at the level of the inferior brainstem and spinal cord junction suggestive of nonspecific myelopathy. On a follow-up visit, additional symptoms reported included increased fatigue and hair loss, but no urinary/bowel symptoms or incontinence, tremor, swallowing difficulties. Medication was changed from Aubagio to Rituximab and NMO antibody testing is pending.
Distinguishing myelin oligodendrocyte glycoprotein antibody disease from multiple sclerosis is critical as the course of disease and treatment vary vastly between the two pathologies. However, the similar, overlapping symptomatology between the two diseases add a level of complexity and can delay proper diagnosis and treatment. Knowledge of the complete clinical spectrum of MOGAD is incomplete, specifically when comparing inflammatory demyelinating diseases such as multiple sclerosis (2).
1. Narayan, R., Simpson, A., Fritsche, K., Salama, S., Pardo, S., Mealy, M., Paul, F., & Levy, M. (2018, July 24). Mog Antibody Disease: A review of Mog Antibody Seropositive Neuromyelitis Optica Spectrum disorder. Multiple Sclerosis and Related Disorders. Retrieved June 25, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S2211034818302360
2. Ciotti, J. R., Eby, N. S., Wu, G. F., Naismith, R. T., Chahin, S., & Cross, A. H. (2020, July 15). Clinical and laboratory features distinguishing Mog antibody disease from multiple sclerosis and AQP4 antibody-positive neuromyelitis optica. Multiple Sclerosis and Related Disorders. Retrieved June 25, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S2211034820304740#preview-section-cited-by
What will audience learn from your presentation?
• Pathophysiology and presentation of myelin oligodendrocyte glycoprotein antibody disease (MOGAD)
• Differentiate myelin oligodendrocyte glycoprotein antibody disease and other demyelinating diseases, specifically multiple sclerosis.
• Broaden the spectrum of knowledge of myelin oligodendrocyte glycoprotein antibody disease to aid in more accurate diagnosis and proper treatment.