Myelin Oligodendrocyte Glycoprotein Antibody (MOG-IgG)-Associated Demyelination (MOGAD) is an inflammatory CNS condition which can present as ADEM or NMOSD clinical picture.  

We report a 28-year-old pregnant woman who presented with acute onset of generalized dysesthesia, pain with eye movements and urinary retention two weeks following a possible tick exposure and had evidence of longitudinally extensive transverse myelitis. She was found to be seropositive for lyme IgM and anti-MOG IgG.

A 28-year-old pregnant woman presented with acute onset of generalized dysesthesia, urinary retention and painful eye movements. Two weeks prior, she had a possible tick exposure and a faint erythematous rash on her leg. 

Exam was positive for low grade fever, sensory loss in lower extremities with sensory level at T5 and generalized hyper-reflexia. 

MRI of the spinal cord revealed STIR hyper intensity in multiple patchy areas in cervical and thoracic regions. Brain MRI was normal. CSF was remarkable for protein of 60 mg/dl and 115 nucleated cells with 83% lymphocytes and normal glucose. Serum lyme IgM was slightly positive. 

Patient was treated with IV methylprednisone with significant improvement in her symptoms. She also received IV ceftriaxone for possible neuroborreliosis. Later, serum MOG-IgG came back positive with titer elevated to 1:10,000. At 3 month follow up, she was completely back to normal and serum lyme IgG was negative. 

MOGAD has been reported to occur in the setting of various infections including HSV, EBV, CMV, chlamydia , VZV, Influenza, HHV-6 and Borrelia burgdorferi. 

In the setting of concurrent certain infections that can also cause CNS involvement, it is a dilemma to blame the infection itself as a culprit or para -infectious autoimmune attacks. 

This case report validates the importance of investigating all reasonably treatable etiologies (i.e. MOG-IgG) even if an initial lab finding may potentially explain the clinical picture (i.e Lyme disease).