Abstract Details

Title Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) or Paraneoplastic Syndrome: A Diagnostic Conundrum

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 059

Objective Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare primary CNS demyelinating disorder. This case reveals diagnostic challenges associated with MOGAD, especially when overlapped with paraneoplastic antibodies.

Background A 46-year old woman with hypertension, anxiety and anemia presented to the ER with waxing and waning episodic vision loss, dysarthria, ataxia and agitation for 3-4 months. After extensive diagnostic workup, repeat studies showed contrast enhancing brainstem and subcortical lesions on MRI Brain and Purkinje Cell Cytoplasmic Type 2 (PCA-2) antibody positive on paraneoplastic panel. She was treated with high dose IV methylprednislone and PLEX, with some improvement in symptoms. Notably, initial myelin oligodendrocyte glycoprotein (MOG) antibody was inconclusive; however, retesting revealed positive titer of 1:1000 supporting the diagnosis of MOGAD.

Design/Methods NA

Results The case aligns with the 2023 diagnostic criteria for MOGAD, highlighting the importance of identifying serum MOG-IgG. However, it simultaneously reveals a positive PCA-2 antibody which may have been contributing to some of patient’s symptoms. Furthermore, the heterogeneous clinical manifestations associated with MOGAD emphasize the challenges in diagnosis and management, particularly given its rarity and potential under-recognition.

Conclusions MOGAD diagnosis relies on identifying serum MOG-IgG via cell based assays; excluding MS and NMOSD; and assessing for a demyelinating event. While this case depicted some typical symptoms of optic neuritis, the challenges arose with the initial PCA-2 antibody positivity, along with relatively uncommon cerebellar signs. The occurrence of residual deficits, as presented here, is uncommon in MOGAD. Further research is warranted on presentation and symptomatology of both antibodies along with their appropriate management.

Authors/Disclosures
Anu Sehgal, MD PRESENTER	Anu Sehgal has nothing to disclose.
Ramsha A. Bhutta, MD (St. Francis-Emory Healthcare)	Dr. Bhutta has nothing to disclose.

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