Anti-MOG Positive Bilateral Optic Neuritis and Brainstem Encephalitis Secondary to COVID-19 Infection: A Case Report

Tsouris, Zisis; Provatas, Antonios; Bakirtzis, Christos; Aloizou, Athina-Maria; Siokas, Vasileios; Tsimourtou, Vana; Grigoriadis, Nikolaos; Hadjigeorgiou, Georgios M.; Dardiotis, Efthimios

doi:10.3390/neurolint14040078

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Finally, one more case of anti MOG antibodies in the serum and CSF was most recently reported by Tsouris et al [ 17 ]. To our knowledge, 42 cases of definite COVID-19-associated AE have been reported, with 13 of them definitely diagnosed by revealing novel antineuronal autoantibodies with indirect immunofluorescence in the CSF.…”

Section: Discussionmentioning

confidence: 88%

Cerebrospinal Fluid Anti-Neuronal Autoantibodies in COVID-19-Associated Limbic Encephalitis with Acute Cerebellar Ataxia and Myoclonus Syndrome: Case Report and Literature Review

et al. 2023

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Since the outbreak of coronavirus (COVID-19) in 2019, various rare movement disorders and cognitive changes have been recognized as potential neurological complications. The early treatment of some of these allows rapid recovery; therefore, we must diagnose these manifestations in a timely way. We describe the case of a 76-year-old man infected with severe acute respiratory syndrome coronavirus-2 who presented with confusion and hallucinations and was admitted to our hospital 14 days after the onset of symptoms. One day later, he developed generalized myoclonus, dysarthria and ataxia, and tonic clonic seizures and was admitted to the intensive care unit. A diagnosis of COVID-19-associated autoimmune encephalitis with characteristics of limbic encephalitis and immune-mediated acute cerebellar ataxia and myoclonus syndrome was supported by alterations in the limbic system shown in magnetic resonance imaging, lateralized discharges shown in electroencephalography, a slightly elevated protein level in the cerebrospinal fluid (CSF), and indirect immunofluorescence in the CSF with autoantibody binding to anatomical structures of the cerebellum and hippocampus. The patient improved with 2 weeks of corticosteroid treatment and four sessions of plasmapheresis. Our current case study describes a rare case of COVID-19-related limbic encephalitis with immune-mediated acute cerebellar ataxia and myoclonus syndrome (ACAM syndrome) and strengthens the need for tissue-based assays (TBAs) to screen the serum and/or CSF of patients highly suspected to have autoimmune encephalitis. We believe that the timely diagnosis and targeted aggressive immunotherapy were mainly responsible for the patient’s total recovery.

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Section: Discussionmentioning

confidence: 88%

Cerebrospinal Fluid Anti-Neuronal Autoantibodies in COVID-19-Associated Limbic Encephalitis with Acute Cerebellar Ataxia and Myoclonus Syndrome: Case Report and Literature Review

et al. 2023

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“…Ocular tropism of SARS-CoV-2 was confirmed in a mouse model manifesting retinal inflammation with production of pro-inflammatory cytokines in the eyes of intranasally (IN)-infected mice (162). Finally, an autoimmune mechanism may also be at play in patients with COVID-19 optic neuritis due to anti-MOG antibodies (myelin oligodendrocyte glycoprotein) (163,164).…”

Section: Ophthalmic Problemsmentioning

confidence: 95%

A review of cytokine-based pathophysiology of Long COVID symptoms

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Akrami

2023

Front. Med.

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The Long COVID/Post Acute Sequelae of COVID-19 (PASC) group includes patients with initial mild-to-moderate symptoms during the acute phase of the illness, in whom recovery is prolonged, or new symptoms are developed over months. Here, we propose a description of the pathophysiology of the Long COVID presentation based on inflammatory cytokine cascades and the p38 MAP kinase signaling pathways that regulate cytokine production. In this model, the SARS-CoV-2 viral infection is hypothesized to trigger a dysregulated peripheral immune system activation with subsequent cytokine release. Chronic low-grade inflammation leads to dysregulated brain microglia with an exaggerated release of central cytokines, producing neuroinflammation. Immunothrombosis linked to chronic inflammation with microclot formation leads to decreased tissue perfusion and ischemia. Intermittent fatigue, Post Exertional Malaise (PEM), CNS symptoms with “brain fog,” arthralgias, paresthesias, dysautonomia, and GI and ophthalmic problems can consequently arise as result of the elevated peripheral and central cytokines. There are abundant similarities between symptoms in Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). DNA polymorphisms and viral-induced epigenetic changes to cytokine gene expression may lead to chronic inflammation in Long COVID patients, predisposing some to develop autoimmunity, which may be the gateway to ME/CFS.

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“…MOGAD is an autoimmune disease that has been proposed in recent years to manifest as CNS demyelination in both adults and children independent of multiple sclerosis and neuromyelitis optica spectrum disorders [ 2 ]. MOGAD may be preceded by a predisposing factor such as infection, which accounts for 37%-70% of cases [ 3 ], and most commonly viral infections, including influenza virus, Epstein-Barr virus, herpes simplex virus, acute respiratory syndrome coronavirus, and novel coronaviruses [ 4 - 6 ]. In contrast, positive expression of MOG-IgG induced by suppurative meningoencephalitis is relatively rare.…”

Section: Introductionmentioning

confidence: 99%

Manifestations of Myelinating Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Rare Case of Suppurative Meningoencephalitis

Xiang

2024

Cureus

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Myelinating oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disease of the central nervous system (CNS) mediated by MOG antibodies (MOG-IgG). It is associated with autoimmunity and encompasses various syndromes. However, manifestations presenting with symptoms of suppurative meningoencephalitis are rare. In this case, we admitted an 80-year-old male patient who presented with fever, headache, mental and behavioral abnormalities, and disturbance of consciousness. The cerebrospinal fluid (CSF) examination revealed elevated levels of leukocytes and protein, while magnetic resonance imaging (MRI) of the brain showed an abnormal signal in the parietal lobe surrounding the posterior horn of the right lateral ventricle. The patient tested positive for serum MOG-IgG, confirming the diagnosis of MOG-IgG-related meningoencephalitis. The treatment included intravenous immunoglobulin, glucocorticoids, third-generation cephalosporins, and immunosuppressants. Following the treatment, the patient experienced complete recovery.

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Anti-MOG Positive Bilateral Optic Neuritis and Brainstem Encephalitis Secondary to COVID-19 Infection: A Case Report

Cited by 5 publications

References 13 publications

Cerebrospinal Fluid Anti-Neuronal Autoantibodies in COVID-19-Associated Limbic Encephalitis with Acute Cerebellar Ataxia and Myoclonus Syndrome: Case Report and Literature Review

Cerebrospinal Fluid Anti-Neuronal Autoantibodies in COVID-19-Associated Limbic Encephalitis with Acute Cerebellar Ataxia and Myoclonus Syndrome: Case Report and Literature Review

A review of cytokine-based pathophysiology of Long COVID symptoms

Manifestations of Myelinating Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Rare Case of Suppurative Meningoencephalitis

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