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MOG-Ab-associated optic neuritis with concurrent GFAP-Ab positivity following tislelizumab-based treatment: a case
Yinghui Zhang1, Yonghu Liu2, Hongxia Xin2
1Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Objective:
To investigate the clinical characteristics and therapeutic management of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-related optic neuritis (ON), a rare neurological immune-related adverse event (irAE) associated with the programmed death-1 (PD-1) inhibitor tislelizumab.
Methods:
We report a retrospective case of a 48-year-old male patient with extensive-stage small cell lung cancer (ES-SCLC) who developed acute bilateral vision loss after receiving the first dose of tislelizumab combined with chemotherapy. After admission to the neurology department and a systematic clinical evaluation, the patient was found to be positive for both MOG-Ab and glial fibrillary acidic protein antibody (GFAP-Ab). He was ultimately diagnosed with MOG-Ab-associated ON with Concurrent GFAP-Ab Positivity.
Results:
Following diagnosis, tislelizumab was promptly discontinued. The patient received high-dose methylprednisolone (1,000 mg/d) as initial therapy, followed by sequential tapering combined with rituximab for immunomodulation. This regimen resulted in considerable visual recovery. In subsequent treatment lines, immune checkpoint inhibitors (ICIs) were avoided.
Conclusion:
This case underscores the potential of PD-1 inhibitors to trigger rare MOG-Ab-associated ON. For such vision-threatening irAEs, early recognition, immediate ICI withdrawal, multidisciplinary collaboration, and aggressive immunosuppressive therapy are essential for reversing neurological impairment and improving outcomes.