MOGAD-Associated Recurrent Optic Neuritis Unresponsive to Corticosteroids: Clinical, Visual Field, and OCT...

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune demyelinating disorder. In adults, optic neuritis is the most common initial manifestation.

We report the case of a 23-year-old woman presenting with right eye vision loss and severe optic disc edema. The condition was unresponsive to intravenous corticosteroids. Plasmapheresis led to marked improvement. Two months later, a second episode occurred in the left eye, despite ongoing steroid therapy.

Initial brain and orbital MRI were normal. Optical coherence tomography (OCT) showed increased RNFL thickness in the acute phase and progressive thinning during follow-up. Anti-MOG antibodies were detected at a 1:100 titer in serum, confirming the diagnosis.

The patient was treated with plasmapheresis, oral steroids, and azathioprine during the first attack. After the second relapse, rituximab was initiated. The patient achieved visual recovery and has remained relapse-free for two years.

Corticosteroid-unresponsive recurrent optic neuritis should prompt evaluation for MOGAD, especially in the presence of bilateral involvement and optic disc edema. OCT is valuable for monitoring disease activity and structural damage.