Optic neuritis of MOG-IgG-associated autoimmune disorders: a case report

• Published in: BMC ophthalmology 2021-01, Vol.21 (1), p.24-24, Article 24
• Main Authors: Li, Tiantian, Zhou, Jian, Yan, Xiaoling, Duan, Ran, Zhu, Xiaobo
• Format: Article
• Language: English
• Subjects: Adult; Antibodies; Antibody testing; Aquaporin 4; Autoantibodies; Autoimmune diseases; Autoimmune Diseases - diagnosis; Autoimmune Diseases - drug therapy; Case Report; Case reports; Demyelination; Diagnosis; Encephalomyelitis; Evoked Potentials, Visual; Female; Glycoproteins; Herpes viruses; Humans; Immunofluorescence; Immunoglobulin G; Magnetic resonance imaging; Middle Aged; Multiple sclerosis; Multiple sclerosis (MS); Myelin; Myelin oligodendrocyte glycoprotein (MOG) antibodies; Myelin proteins; Myelitis; Nervous system; Neuritis; Neuromyelitis Optica; Neuromyelitis optica spectrum disorders (NMOSD); Oligodendrocyte-myelin glycoprotein; Ophthalmology; Optic nerve; Optic neuritis; Optic neuritis (ON); Optic Neuritis - diagnosis; Optic Neuritis - drug therapy; Optic Neuritis - etiology; Patients; Remission; Rubella; Spinal cord; Vertebrae
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-020-01780-8

The diagnosis of immunoglobulin G serum antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) associated inflammatory demyelinating disorders can be confirmed by the presence of MOG-IgG, yet its general cut-off concentration had not yet to be defined. Whether it is significant that a seropositive lower titer level for MOG-IgG could cause disease is still unknown. A 55-year-old Chinese woman presented with acute optic neuritis manifestations in the left eye. MRI showed a left optic nerve demyelination image and a T2 hyperintensity at C7 vertebral segment without any extra specific lesions. AQP4-IgG was tested seronegative, while the MOG-IgG was positive, titer 1:10, by indirect immunofluorescence. Considering the lower concentration, we retested serum MOG-IgG after 6 months of steroid therapy, using cell-based assay, then we still got the same result which was also barely above the negative cut-off value. So, the clinical diagnose was "possible MOG-IgG-associated encephalomyelitis". The woman's condition improved by steroid therapy without relapse. Seropositive MOG-IgG, even at a lower level, could lead to an autoimmune inflammatory demyelination. In adults, it commonly presents as ON and myelitis. Although the patient had a considerable reaction, steroid therapy could not make MOG-IgG seronegative, instead, the antibody may persist even during remission and flare-ups can recur after steroid withdrawal. Therefore, a long-term follow-up is necessary to monitor the patient's prognosis.