Successful intravenous immunoglobulin treatment in relapsing MOG-antibody-associated disease

Treatment of MOG Ab-associated disease is poorly standardized: several drugs have been employed, with variable results. A 50-year-old Caucasian male was admitted to hospital in 2009, with severe acute transverse myelitis. A brain and spinal cord MRI showed multiple demyelinating lesions and cerebrospinal fluid analysis revealed no oligoclonal bands (OCBs). A diagnosis of multiple sclerosis (MS) was made. He was treated with interferon-beta 1a, then with fingolimod, and finally with rituximab. All these treatments were ineffective: he experienced several spinal and brainstem relapses, with residual disability. Finally, an empirical therapy with IVIg was started. Calling into question the diagnosis of MS, we performed anti-MOG test (positive). IVIg therapy was continued and the patient experienced only one mild relapse during a 24-month follow-up. Our patient, with an aggressive and atypical MOG Ab-associated disease, showed a very good response to longterm IVIg treatment.