Prolonged Fever: An Atypical Presentation in MOG Antibody-Associated Disorders

Area of Science:

• Neurology
• Pediatrics
• Immunology

Background:

• Myelin oligodendrocyte glycoprotein antibody-associated demyelinating disorders (MOGAD) are increasingly diagnosed in children.
• Unusual clinical presentations of MOGAD are expanding the understanding of this condition.
• Prolonged fever (PF) has been identified as a significant symptom in pediatric MOGAD cases.

Purpose of the Study:

• To report on 12 pediatric cases of MOGAD where prolonged fever was a prominent feature.
• To describe the diverse clinical presentations associated with MOGAD and prolonged fever in children.
• To emphasize the importance of considering MOGAD in the differential diagnosis of specific pediatric conditions.

Main Methods:

• Prospective recruitment and follow-up of pediatric patients over 2 years.
• Analysis of clinical data, imaging, and cerebrospinal fluid findings.
• Categorization of patients based on the timing of fever and demyelination.

Main Results:

• Eight out of twelve patients showed delayed clinical/imaging evidence of demyelination.
• Presentations included fever of unknown origin (4/12), aseptic meningitis (4/12), and PF with acute demyelination (4/12).
• Common findings were leukocytosis, elevated inflammatory markers, and cerebrospinal fluid pleocytosis; early seizures were noted.

Conclusions:

• Prolonged fever is an important component of the pediatric MOGAD symptom complex.
• MOGAD should be considered in the differential diagnosis for children presenting with prolonged fever, fever of unknown origin, or aseptic meningitis.
• Timely recognition of MOGAD can aid in appropriate management and prevent diagnostic delays.