A case of MOG antibody-associated disease with encephalomyelitis after the onset of subacute meningitis

DOI
  • Tayama Takahiro
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima Department of Pediatrics, Tokushima University Hospital, Tokushima
  • Takeuchi Shunsuke
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Takei Mikiko
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Fujioka Keisuke
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Ono Akemi
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Shono Miki
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Shichijo Koichi
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Kondo Shuji
    Department of Pediatrics, Tokushima Prefectural Central Hospital, Tokushima
  • Fukura Shoko
    Department of Pediatrics, Tokushima University Hospital, Tokushima
  • Goji Aya
    Department of Pediatrics, Tokushima University Hospital, Tokushima
  • Mori Tatsuo
    Department of Pediatrics, Tokushima University Hospital, Tokushima
  • Takahashi Toshiyuki
    Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi

Bibliographic Information

Other Title
  • 亜急性髄膜炎で発症後に，脳脊髄炎を呈したMOG抗体関連疾患の1例

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Abstract

<p>  There are some reports of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) preceded by meningitis. Most of them show abnormal findings on T2-weighted and fluid-attenuated inversion recovery sequence brain magnetic resonance imaging (MRI), whereas only a few report entirely normal imaging findings. We report a case of MOGAD preceded by aseptic meningitis in a 4-year-old girl hospitalized for prolonged fever, headache, and vomiting. A cerebrospinal fluid test revealed an elevated cell count, but the brain MRI was unremarkable. After the diagnosis of subacute meningitis, she was unsuccessfully treated with antibiotics and anti-herpes drugs. Three weeks after the onset of subacute meningitis symptoms, she experienced hallucinations, and her EEG revealed an extensive slow waves. Brain MRI remained unremarkable. After a while, she developed spinal cord symptoms. Spinal cord MRI revealed a T2 high-signal lesion in the thoracic region. We diagnosed her with encephalomyelitis and initiated intravenous methylprednisolone pulse therapy (IVMP). Further testing revealed MOG antibody positivity, and she was diagnosed with MOGAD. She was treated with IVMP and intravenous immunoglobulin with a poor response ; thus, we initiated plasma exchange (PE) which improved her symptoms. Although acute disseminated encephalomyelitis often precedes MOGAD in children, MOGAD should be considered in the differential diagnosis of aseptic meningitis with unremarkable brain MRI.</p>

Journal

  • NO TO HATTATSU

    NO TO HATTATSU 55 (5), 363-367, 2023

    The Japanese Society of Child Neurology

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