Dados do Trabalho

Título

CHALLENGING DIAGNOSIS OF MYELIN OLIGODENDROCYTE GLYCOPROTEIN (MOG) ANTIBODY - POSITIVE OPTIC NEURITIS

Apresentação do caso

Ten year-old female presented whit visual loss and ocular pain with extraocular movements in the left eye and papilledema. After 15 days, it progressed to the right eye. No other neurological symptoms were observed. The case was investigated with optical nerve magnetic resonance imaging (MRI), which evidenced enhancement of the optical nerve with perineural involvement, and brain and spinal cord MRI without demyelination. Cerebrospinal fluid demonstrated pleocytosis (31 cells) and gammaglobulin increase (19%), without oligoclonal immunoglobulin G bands elevation. Anti-aquaporin-4 (AQP4) IgG, by Cell Based Assay, presented negative. Treatment with methylprednisolone was initiaded, with adequate response. After 1 and 3 years, there were relapses, with similar symptoms of neuritis. Imaging in MRI (brain, optic nerve and spinal cord) was maintained, and no other neurological alterations were observed. After the last attack, testing for MOG-IgG became available, which presented positive results. Treatment with steroids and azathioprine was sustained, without new acute attack until this moment.

Discussão

The presentation of MOG-IgG-positive optic neuritis is diverse. In most cases it is recurrent and may occur with or without other neurological symptoms. It should be suspected when severe optic disc edema and optic nerve sheath involvement in MRI are observed and AQP4-IgG is negative. Compared to AQP4-IgG-positive patients better outcomes for visual recovery are expected, despite recurrence and severe visual loss during attacks.

Comentários finais

MOG-IgG antibody testing has become more available, and it provides the correct diagnosis and differentiate it from multiple sclerosis. Therefore this dignostic test is important to predict the prognosis and to guide the treatment.

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Área

Neuroimunologia, esclerose múltipla e outras doenças desmielinizantes