Coexistent anti-GFAP and anti-MOG antibodies presenting with isolated meningitis and papillitis: more support for...

Area of Science:

• Neuroimmunology
• Autoimmune Neurology

Background:

• Anti-myelin oligodendrocyte glycoprotein (MOG)-associated disorders and anti-glial fibrillar acidic protein (GFAP) conditions are distinct central nervous system demyelinating diseases.
• While multiple autoantibodies can coexist, the simultaneous presence of MOG and GFAP antibodies is exceptionally rare, with only two prior reports.
• GFAP-associated conditions typically present as severe meningoencephalomyelitis with papillitis.

Purpose of the Study:

• To report the third known case of overlapping anti-GFAP and anti-MOG antibody-associated syndrome.
• To contribute to the understanding of the phenotypic spectrum of these rare autoimmune disorders.
• To highlight the potential for overlapping pathophysiological mechanisms.

Main Methods:

• A case study of a 53-year-old male patient presenting with neurological symptoms.
• Cerebrospinal fluid analysis for autoantibodies, including anti-GFAP and anti-MOG.
• Comprehensive immunological and infectious workup.
• Neurological imaging.

Main Results:

• The patient presented with headache, fevers, and asymptomatic papillitis, later diagnosed with self-limited lymphocytic meningitis.
• Cerebrospinal fluid testing revealed the presence of both anti-GFAP and anti-MOG antibodies.
• The patient achieved a full recovery without requiring immunotherapy.
• Extensive investigations for other causes were negative, and imaging was largely unremarkable.

Conclusions:

• This case represents the third documented instance of co-occurring anti-GFAP and anti-MOG antibodies, expanding the recognized phenotype.
• Clinicians should consider testing for both GFAP and MOG antibodies in unexplained meningitis, especially when accompanied by papillitis.
• This case may offer insights into the underlying pathophysiology of these distinct yet potentially overlapping autoimmune conditions.