Abstract Details

Title An Unsolved Case of MOGAD: Hindsight is 20/20 in 2025

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 02 (3:00 PM-4:00 PM)

Poster/Presentation
Number 1-046

Objective We report a case of relapsing MOGAD, previously diagnosed as POMS.

Background Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) is a demyelinating disease that may present across all age groups and has clinical, radiographic, and immunologic features distinguishing this disease from multiple sclerosis (MS).Up to 5% of suspected pediatric onset multiple sclerosis (POMS) cases are found to have MOGAD.

Design/Methods NA

Results A 28-year-old female was initially hospitalized in 2004 at age 6 with afebrile focal onset status epilepticus. One month later she presented with lethargy and meningismus. MRI showed T2 FLAIR hyper-intensities in the bilateral temporal lobes, brainstem, and subcortical white and gray matter, with mild leptomeningeal enhancement. She had a negative infectious workup and was treated for ADEM with IVIG and IV methylprednisolone. Over the next three years, she presented with recurrent optic neuritis and behavioral disturbances. Repeat MRI imaging during this period showed involvement of the optic nerves, cerebellum, and cervical spinal cord. AQP4-IgG testing was negative. CSF studies showed a lymphocytic pleocytosis, with oligoclonal bands not drawn. A diagnosis of POMS was made at age 12 and she was started on glatiramer acetate. Disease activity ceased after age 15. On presentation to our clinic, she had evidence of severe retinal nerve fiber layer thinning bilaterally on optical coherence tomography. As her clinical history and neuroimaging were atypical of MS and more consistent with MOGAD, serum MOG-IgG was sent and found to be positive with 1:100 titer.

Conclusions This case emphasizes key features distinguishing MOGAD from MS including age of onset, ADEM presentation, and recurrent bilateral optic neuritis. Thus, patients with an atypical clinical presentation for MS may warrant reevaluation of the initial diagnosis. Future research should focus on the utility of routine screening and treatment guidelines for monophasic versus relapsing cases of MOGAD.

Authors/Disclosures
Shivani Venkatesh, DO PRESENTER	Dr. Venkatesh has nothing to disclose.
Samuel B. Marcucci, MD (UC Health Department of Neurology and Rehabilitation Medicine)	The institution of Mr. Marcucci has received research support from Foundation of the Consortium of Multiple Sclerosis Centers.
Tim Nguyen, MD (Cincinnati Children's Hospital Medical Center)	Dr. Nguyen has nothing to disclose.
Dan Chapman, DO (UC Department of Neurology & Rehabilitation Medicine)	Dr. Chapman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Chapman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Chapman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Chapman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Chapman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for TG Therapeutics.

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