serum MOG-Abs define a distinct entity of inflammatory demyelinating diseases, characterised by subacute onset of predominantly optic nerve and/or spinal cord involvement. Recently, we proposed to extend the analysis of MOG-Abs in the CSF of highly suggestive seronegative cases to increase diagnostic sensitivity. However, the exact value of CSF MOG-Abs needs further confirmations.

a 81-year-old man presented with urinary retention followed by paraplegia and L1 sensory level loss. Spinal cord MRI showed multiple T2 hyperintense lesions in brainstem and spinal cord, a tumefactive central lesion extending from T9 to the conus, homogeneous and diffuse meningeal enhancement along the surface of brainstem and spinal cord together with thickening and enhancement of lumbosacral nerve roots. CSF analysis revealed increased protein content (5.2 g/L), mild lymphocytic pleocytosis (29 cells/μL) and oligoclonal bands (pattern 3). Investigations for infectious and haematological conditions yielded negative results. On autoimmune screening, CSF only MOG-Abs were detected with live cell-based assay. Despite treatment with high-dose intravenous steroids, the clinical picture rapidly deteriorated to upper limbs weakness, multiple cranial nerves involvement, and severe dysautonomia. The patient died 15 days after symptoms onset.

we herein report the first spinal cord pathological evaluation of a patient with isolated CSF MOG-Abs. Pathological findings, compatible with a subacute inflammatory process, further reinforce the importance of testing MOG-Abs in the CSF of highly suggestive cases.