Relapsing optic neuritis and meningoencephalitis in a child: Case report of delayed diagnosis of MOG-IgG syndrome

Xiaonan Zhong, Yanyu Chang, Sha Tan, Jingqi Wang, Xiaobo Sun, Aimin Wu, Lisheng Peng, Alexander Y. Lau, Allan G. Kermode, Wei Qiu

    Research output: Contribution to journalArticle

    Abstract

    Background: Recurrent optic neuritis (ON) was previously thought to be associated with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Meningoencephalitis has recently been suggested to be a clinical finding typical of myelin oligodendrocyte glycoprotein (MOG) encephalomyelitis. We report a Chinese patient with recurrent ON at disease initiation, who had a delayed diagnosis of MOG-IgG syndrome, until recurrent meningoencephalitis appeared and serum MOG-IgG was detected. Case presentation: From the age of 7 years, an AQP4-IgG negative female patient had 10 disease recurrences, including 4 episodes of recurrent ON, 4 episodes of fever and meningoencephalitis, and 2 episodes of ON as well as meningoencephalitis. She was initially diagnosed as recurrent ON and treated with glucocorticoids followed by gradual tapering when ON reoccurred. Later, she was diagnosed as central nervous system infection when fever and meningoencephalitis appeared, and antiviral drugs and glucocorticoids were used. However, when she returned to our department for follow-up on July 2017, the results of serum demyelinating autoimmune antibody revealed positive MOG-IgG (titer 1:320 by an in-house, cell-based assay using live cells transfected with full-length human MOG). A diagnosis of MOG-IgG syndrome was established. Conclusions: Testing for MOG-IgG in atypical MS and NMOSD patients, and patients with meningoencephalitis with a history of relapsing demyelinating symptoms is warranted.

    Original languageEnglish
    Article number94
    Pages (from-to)490-490
    JournalBMC Neurology
    Volume19
    Issue number1
    DOIs
    Publication statusPublished - 9 May 2019

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    Myelin-Oligodendrocyte Glycoprotein
    Optic Neuritis
    Meningoencephalitis
    Delayed Diagnosis
    Immunoglobulin G
    Neuromyelitis Optica
    Glucocorticoids
    Multiple Sclerosis
    Fever
    Encephalomyelitis
    Central Nervous System Infections
    Serum
    Antiviral Agents
    Recurrence
    Antibodies

    Cite this

    Zhong, Xiaonan ; Chang, Yanyu ; Tan, Sha ; Wang, Jingqi ; Sun, Xiaobo ; Wu, Aimin ; Peng, Lisheng ; Lau, Alexander Y. ; Kermode, Allan G. ; Qiu, Wei. / Relapsing optic neuritis and meningoencephalitis in a child : Case report of delayed diagnosis of MOG-IgG syndrome. In: BMC Neurology. 2019 ; Vol. 19, No. 1. pp. 490-490.
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    title = "Relapsing optic neuritis and meningoencephalitis in a child: Case report of delayed diagnosis of MOG-IgG syndrome",
    abstract = "Background: Recurrent optic neuritis (ON) was previously thought to be associated with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Meningoencephalitis has recently been suggested to be a clinical finding typical of myelin oligodendrocyte glycoprotein (MOG) encephalomyelitis. We report a Chinese patient with recurrent ON at disease initiation, who had a delayed diagnosis of MOG-IgG syndrome, until recurrent meningoencephalitis appeared and serum MOG-IgG was detected. Case presentation: From the age of 7 years, an AQP4-IgG negative female patient had 10 disease recurrences, including 4 episodes of recurrent ON, 4 episodes of fever and meningoencephalitis, and 2 episodes of ON as well as meningoencephalitis. She was initially diagnosed as recurrent ON and treated with glucocorticoids followed by gradual tapering when ON reoccurred. Later, she was diagnosed as central nervous system infection when fever and meningoencephalitis appeared, and antiviral drugs and glucocorticoids were used. However, when she returned to our department for follow-up on July 2017, the results of serum demyelinating autoimmune antibody revealed positive MOG-IgG (titer 1:320 by an in-house, cell-based assay using live cells transfected with full-length human MOG). A diagnosis of MOG-IgG syndrome was established. Conclusions: Testing for MOG-IgG in atypical MS and NMOSD patients, and patients with meningoencephalitis with a history of relapsing demyelinating symptoms is warranted.",
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    Zhong, X, Chang, Y, Tan, S, Wang, J, Sun, X, Wu, A, Peng, L, Lau, AY, Kermode, AG & Qiu, W 2019, 'Relapsing optic neuritis and meningoencephalitis in a child: Case report of delayed diagnosis of MOG-IgG syndrome' BMC Neurology, vol. 19, no. 1, 94, pp. 490-490. https://doi.org/10.1186/s12883-019-1324-4

    Relapsing optic neuritis and meningoencephalitis in a child : Case report of delayed diagnosis of MOG-IgG syndrome. / Zhong, Xiaonan; Chang, Yanyu; Tan, Sha; Wang, Jingqi; Sun, Xiaobo; Wu, Aimin; Peng, Lisheng; Lau, Alexander Y.; Kermode, Allan G.; Qiu, Wei.

    In: BMC Neurology, Vol. 19, No. 1, 94, 09.05.2019, p. 490-490.

    Research output: Contribution to journalArticle

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    AU - Chang, Yanyu

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    AU - Wang, Jingqi

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    AB - Background: Recurrent optic neuritis (ON) was previously thought to be associated with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Meningoencephalitis has recently been suggested to be a clinical finding typical of myelin oligodendrocyte glycoprotein (MOG) encephalomyelitis. We report a Chinese patient with recurrent ON at disease initiation, who had a delayed diagnosis of MOG-IgG syndrome, until recurrent meningoencephalitis appeared and serum MOG-IgG was detected. Case presentation: From the age of 7 years, an AQP4-IgG negative female patient had 10 disease recurrences, including 4 episodes of recurrent ON, 4 episodes of fever and meningoencephalitis, and 2 episodes of ON as well as meningoencephalitis. She was initially diagnosed as recurrent ON and treated with glucocorticoids followed by gradual tapering when ON reoccurred. Later, she was diagnosed as central nervous system infection when fever and meningoencephalitis appeared, and antiviral drugs and glucocorticoids were used. However, when she returned to our department for follow-up on July 2017, the results of serum demyelinating autoimmune antibody revealed positive MOG-IgG (titer 1:320 by an in-house, cell-based assay using live cells transfected with full-length human MOG). A diagnosis of MOG-IgG syndrome was established. Conclusions: Testing for MOG-IgG in atypical MS and NMOSD patients, and patients with meningoencephalitis with a history of relapsing demyelinating symptoms is warranted.

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