Isolated recurrent myelitis in a persistent MOG positive patient

Area of Science:

• Neuroimmunology
• Neurology
• Demyelinating Diseases

Background:

• Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) associated demyelination commonly affects the optic nerve and spinal cord.
• Recurrent myelitis without optic neuritis is a rare presentation, accounting for only 3-5% of MOG-Ab positive cases.

Purpose of the Study:

• To report a rare case of recurrent transverse myelitis without optic involvement in a MOG-Ab positive patient.
• To emphasize the importance of screening for MOG-Ab in patients presenting with isolated or recurrent myelitis.

Main Methods:

• Case report of a 30-year-old woman with MOG-Ab positive transverse myelitis.
• Repeated serum MOG-Ab testing after relapse.
• Review of current literature on MOG-Ab associated demyelination.

Main Results:

• The patient experienced two distinct episodes of transverse myelitis without any ophthalmic involvement.
• Serum MOG-Ab remained positive after the second relapse, indicating a high likelihood of relapsing disease.
• The patient relapsed despite Rituximab therapy, suggesting potential treatment challenges in MOG-Ab positive patients.

Conclusions:

• Isolated or recurrent myelitis without optic nerve involvement warrants MOG-Ab IgG screening.
• MOG-Ab positive patients may experience disease relapse even under Rituximab therapy.
• This case underscores the diagnostic importance of considering MOG-Ab in atypical presentations of CNS demyelination.