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Relapsing optic neuritis and meningoencephalitis in a Child-Delayed diagnosis of MOG-IgG syndrome

Zhong, X., Chang, Y., Tan, S., Wang, J., Sun, X., Wu, A., Peng, L., Lau, A.Y., Kermode, A.G. and Qiu, W. (2018) Relapsing optic neuritis and meningoencephalitis in a Child-Delayed diagnosis of MOG-IgG syndrome. Multiple Sclerosis Journal, 25 (3). p. 490.

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Background: Recurrent optic neuritis (ON) is used to consider being associated with multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD). Meningoencephalitis has recently become recommended indications for clinical findings typical of MOG encephalomyelitis.

Object: We herein report a Chinese patient with recurrent ON at the disease beginning, who was delayed diagnosis of MOG-IgG syndrome, until recurrent meningoencephalitis appeared and serum MOG-IgG was detected.

Methods: The clinical feature of a serum MOG-IgG positive child with relapsing ON and meningoencephalitis was described.

Results: From the age of 7 years old, an AQP4-IgG negative female patient had a total of 10 recurrences, including 4 times of recurrent ON, 4 times of fever and meningoencephalitis, and 2 times of ON along with meningoencephalitis. She was initially diagnosed as recurrent ON and treated with glucocorticoid followed by gradually tapering in the recurrence of ON. Later, she was diagnosed as central nervous system infection when fever and meningoencephalitis appeared, and antiviral drugs and glucocorticoid were used. However, when she came back to our department for follow up on July 2017, the results of serum demyelinating autoimmune antibody revealed positive MOG-IgG (titer 1:320)( in-house, cell-based assay using live cells transfected with full-length human MOG). The diagnosis of MOG-IgG syndrome was established.

Conclusions: MOG-IgG syndrome has symptoms similar to MS and NMOSD, and is easily confused. However, meningoencephalitis is helpful for differential diagnosis. Not only MS patients but also atypical NMOSD patients need to detect MOG-IgG.

Item Type: Journal Article
Murdoch Affiliation(s): Institute for Immunology and Infectious Diseases
Publisher: Sage Publications
Other Information: Poster presentation - PACTRIMS 2018
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