Dataset Information

Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) optic perineuritis following severe COVID19 infection.

ABSTRACT:

Purpose

To describe the case of bilateral myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) perineuritis following severe COVID19 pneumonia.

Observations

A 56-year-old man presents with bilateral vision loss (BCVA OU of counting fingers) following severe COVID19 infection. Neuroimaging revealed bilateral perineuritis, with MOG-IgG antibody positive (1:20), confirmed by cell-based assay, elevated ESR and CRP (42 mm/h and 8.2 mg/dL, respectively). The patient was started on IV methylprednisolone with significant improvement in visual field testing bilaterally, followed by slow steroid taper. After 6 months, repeat MOG-IgG antibody was negative (seronegative conversion) and inflammatory parameters (ESR and CRP) were within normal limits.

Conclusions and importance

COVID-19 has been previously associated with MOGAD optic perineuritis, mostly with higher antibody titers. This case suggests a new pathophysiological hypothesis in which concomitant cytokine storm in severe COVID-19 disrupts the blood-brain-barrier, leading to the entry of even lower MOG-IgG titers to the central nervous system (CNS) and exacerbate severe visual loss. Clinicians should be aware of the association of COVID-19 and MOGAD.

SUBMITTER: Leitao M

PROVIDER: S-EPMC10708987 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) optic perineuritis following severe COVID19 infection.

Leitão Miguel M Siliezar Pamela Davila PD Laylani Noor N Lee Andrew G AG

American journal of ophthalmology case reports 20231114

<h4>Purpose</h4>To describe the case of bilateral myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) perineuritis following severe COVID19 pneumonia.<h4>Observations</h4>A 56-year-old man presents with bilateral vision loss (BCVA OU of counting fingers) following severe COVID19 infection. Neuroimaging revealed bilateral perineuritis, with MOG-IgG antibody positive (1:20), confirmed by cell-based assay, elevated ESR and CRP (42 mm/h and 8.2 mg/dL, respectively). The patient was started ...[more]

PMID: 38077781

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Project description:Optic neuritis (ON) is a frequent presentation at onset of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The pathophysiology underlying these diseases, especially MOGAD, is still being elucidated. While obesity has been reported to potentially be a risk factor for MS, this has not been explored in NMOSD or MOGAD. We aimed to investigate a possible association between obesity (body mass index [BMI] > 30 kg/m2) in patients with MOGAD, aquaporin 4-IgG positive NMOSD (AQP4-IgG+ NMOSD) or MS. In this multicenter non-interventional retrospective study, data was collected from patients with a first ever demyelinating attack of ON subsequently diagnosed with MOGAD (n = 44), AQP4-IgG+ NMOSD (n = 49) or MS (n = 90) between 2005 and 2020. The following data was collected: age, sex, ethnicity, BMI (documented before corticosteroid treatment), and the ON etiology after diagnostic work-up. A mixed model analysis was performed to assess the potential of obesity or BMI to predict MOGAD-ON, and to distinguish MOGAD-ON from AQP4-IgG+ NMOSD-ON and MS-ON. Main outcome measures included BMI in patients with acute ON and subsequent diagnosis of MOGAD, AQP4-IgG+ NMOSD or MS. A higher BMI was significantly associated with a diagnosis of MOGAD-ON (p < 0.001); in MOGAD patients the mean BMI was 31.6 kg/m2 (standard deviation (SD) 7.2), while the mean BMI was 24.7 kg/m2 (SD 5.3) in AQP4-IgG+ NMOSD patients, and 26.9 kg/m2 (SD 6.2) in MS patients. Mixed-effects multinomial logistic regression, adjusted for age and sex, with obesity as a binary variable, revealed that obesity was associated with a higher odds ratio (OR) of a subsequent MOGAD diagnosis (OR 5.466, 95% CI [2.039, 14.650], p = 0.001) in contradistinction with AQP4-IgG+ NMOSD. This study suggests an association between obesity and MOGAD. Our findings require further exploration, but could have significant pathophysiologic implications if confirmed in larger prospective studies.

Project description:IntroductionMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare demyelinating disorder of the central nervous system. Despite increased recognition of MOGAD as a distinct disease and the availability of sensitive methods of MOG antibody testing, diagnostic challenges remain. We conducted a survey to explore the patient experience from the start of symptoms to final MOGAD diagnosis.MethodsA 23-question online survey (including multiple-choice and free-text responses) covering symptom history, healthcare interactions and impact of diagnosis was emailed to people living with MOGAD by The MOG Project patient advocacy group. People living with MOGAD could share the survey with their caregivers. Anonymised responses were analysed.ResultsIn total, 204 people living with MOGAD or their caregivers from 21 countries completed the survey; most respondents were from North America. Age of symptom onset ranged from 1 to 66 (median 28) years. Symptoms that prompted patients to seek medical care included blurred vision/loss of vision (58.2%), eye pain (35.8%) and difficulty walking (25.4%). Patients most frequently presented to emergency care physicians (38.7%) and primary care doctors (26.0%), with the MOGAD diagnosis most often made by general neurologists (40.4%) or neuro-immunologists (30.0%). Patients saw a median of four doctors before diagnosis, with 26.5% of patients seeing at least six doctors. Although 60.6% of patients received a MOGAD diagnosis within 6 months of experiencing initial health problems, 17.7% experienced a ≥ 5-year delay. More than half of patients (55.4%) received an alternative primary diagnosis before final MOGAD diagnosis. Most respondents (60.6%) reported receiving insufficient information/resources at the time of MOGAD diagnosis. Diagnostic delay was associated with long-term negative consequences for physical health.ConclusionThis survey provides unique insights from people living with MOGAD and their caregivers that could help address the challenges faced in the pathway to final MOGAD diagnosis.

Project description:ObjectiveWe examined a cohort of adults with aquaporin-4 (AQP4) antibody-negative neuromyelitis optica/neuromyelitis optica spectrum disorder (NMO/NMOSD) for antibodies to myelin oligodendrocyte glycoprotein (MOG).MethodsWe performed a flow cytometry cell-based assay using live human lentivirus-transduced cells expressing full-length surface MOG. Serum was tested in 23 AQP4 antibody-negative NMO/NMOSD patients with bilateral and/or recurrent optic neuritis (BON, n = 11), longitudinally extensive transverse myelitis (LETM, n = 10), and sequential BON and LETM (n = 2), as well as in patients with multiple sclerosis (MS, n = 76) and controls (n = 52).ResultsMOG antibodies were detected in 9/23 AQP4 antibody-negative patients with NMO/NMOSD, compared to 1/76 patients with MS and 0/52 controls (p < 0.001). MOG antibodies were detected in 8/11 patients with BON, 0/10 patients with LETM, and 1/2 patients with sequential BON and LETM. Six of 9 MOG antibody-positive patients had a relapsing course. MOG antibody-positive patients had prominent optic disc swelling and were more likely to have a rapid response to steroid therapy and relapse on steroid cessation than MOG antibody-negative patients (p = 0.034 and p = 0.029, respectively). While 8/9 MOG antibody-positive patients had good follow-up visual acuity, one experienced sustained visual impairment, 3 had retinal nerve fiber layer thinning, and one had residual spinal disability.ConclusionsMOG antibodies have a strong association with BON and may be a useful clinical biomarker. MOG antibody-associated BON is a relapsing disorder that is frequently steroid responsive and often steroid dependent. Failure to recognize the disorder early and institute immunotherapy promptly may be associated with sustained impairment.Classification of evidenceThis study provides Class II evidence that MOG antibodies are associated with AQP4 antibody-negative BON (sensitivity 69%, 95% confidence interval [CI] 42%-87%; specificity 99%, 95% CI 93.7%-99.8%).

Dataset Information

Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) optic perineuritis following severe COVID19 infection.

Purpose

Observations

Conclusions and importance

Publications

Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) optic perineuritis following severe COVID19 infection.

Similar Datasets

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