Five pediatric cases of MOG antibody-associated disease experienced during a 3-month period at a single institution

Abstract

  Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a relatively rare inflammatory central nervous system demyelinating disease. Here, we present five cases of MOGAD, which we experienced during a 3-month period. Case 1 : A 10-year-old boy presented with rapidly progressive bilateral visual loss. Contrast-enhanced brain MRI revealed contrast enhancement surrounding the bilateral optic nerves. His intracranial pressure was markedly elevated. The differential diagnoses included optic neuritis, optic perineuritis, and idiopathic intracranial hypertension. Case 2 : A 4-year-old boy developed acute disseminated encephalomyelitis during the evaluation of a prolonged fever. Case 3 : A 4-year-old girl developed a prolonged fever. Contrast-enhanced brain MRI revealed bilateral optic neuritis, multiple lesions in the brain, and leptomeningeal enhancement. Cerebrospinal fluid analysis showed pleocytosis. Case 4 and case 5 involved patients who presented with optic neuritis. All five patients were eventually diagnosed with MOGAD. Two of the five patients had preceding respiratory infection. One of the other patients had nonspecific prodromal symptoms that could have been caused by infection. All cases occurred after the Japanese government relaxed infection control measures against coronavirus infection 2019, reclassifying it as Class 5. The change may have facilitated the spread of viruses in general, possibly causing an increased incidence of immune-mediated diseases. The true epidemiology of MOGAD, including mild and atypical cases, may become clear in the future as disease awareness increases and MOG antibody testing becomes more widespread.