An unusual case of anti-MOG CNS demyelination with concomitant mild anti-NMDAR encephalitis

Area of Science:

• Neuroimmunology
• Neurology
• Demyelinating Diseases

Background:

• Autoimmune encephalitis and demyelinating diseases are distinct neurological conditions.
• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis are typically diagnosed separately.

Observation:

• A patient presented with progressive unsteadiness, narcolepsy, behavioral changes, and psychosis.
• Cerebral MRI revealed demyelinating lesions in the cerebellum, brainstem, thalamus, and peri-ependymal regions.
• The patient tested positive for both myelin oligodendrocyte glycoprotein antibodies (MOG-Abs) and anti-N-methyl-d-aspartate receptor (NMDAR) antibodies in serum and cerebrospinal fluid.

Findings:

• The patient exhibited a rare simultaneous presentation of MOG antibody disease and anti-NMDAR encephalitis.
• Diagnostic assays confirmed the presence of antibodies targeting both myelin oligodendrocyte glycoprotein and N-methyl-d-aspartate receptors.

Implications:

• This case suggests that MOGAD and anti-NMDAR encephalitis can co-exist in a single patient.
• Understanding such co-presentations is crucial for accurate diagnosis and effective treatment strategies in neuroimmunology.
• Further research is needed to explore the mechanisms and clinical outcomes of co-existing demyelinating and encephalitic autoimmune disorders.