Clinical analysis of a patient simultaneously positive for antibodies of myelin oligodendrocyte glycoprotein and anti–N-methyl-D-aspartate receptor

Abstract

Rationale: Myelin oligodendrocyte glycoprotein (MOG) antibody (MOG-Ab) disease (MOG-AD) is a type of demyelinating disease of the central nervous system characterized by a high frequency of optic neuritis (ON) attacks. anti-Nmethyl-D-aspartate receptor (NMDAR) encephalitis (anti-NMDARe) is an autoimmune disorder characterized by memory deficits, conscious disturbance, and seizures. Cases of simultaneous occurrence of MOG-Ab and anti-NMDARe antibody (anti-NMDARe-Ab) are rarely reported and could be mistaken for overlapping MOG-antibody disease (MOG-AD) and NMDARe. The diagnosis of such patients is challenging. Patient concerns: We report the case of a 37-year-old man who presented with recurrent headaches for 3 months and worsening symptoms over 2 weeks. He had a history of ON. He had a generalized seizure after 7 days in the hospital. Diagnosis: Brain magnetic resonance imaging (MRI) and cerebrospinal fluid tests showed no apparent abnormalities. Repeat MRI showed slight lesions 7 days later, and cerebrospinal fluid tests showed the simultaneous occurrence of MOG-Ab and anti-NMDARe-Ab. Interventions: He completely recovered after treatment with low doses of oral corticosteroids. Outcomes: Two months and 2 years follow-up showed that his condition was stable. Lessons: The co-occurrence of MOG-Ab and anti-NMDAR-Ab does not indicate the co-occurrence of MOG-AD and anti-NMDARe. Laboratory findings should be combined with the clinical features to achieve an accurate and suitable diagnosis.

Autoimmune diseases and cancers overlapping with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): A systematic review

“… 3 This finding implies a difference in the immunopathogenic mechanisms involved in the development of each entity, such that AQP4-IgG + NMOSD is more attributable to a defect in immune tolerance, while MOGAD is more likely to be an aberrant autoimmune response to certain triggers, such as infection, vaccination, or malignancy. 3 …”

“…The major finding of our study was that the most frequent autoimmune disorder that has been reported to co-exist with MOGAD is anti-NMDAR-EN, which is a similar finding to previous studies. 53 Some studies have referred to this co-occurrence as “overlapping syndrome of MOGAD and anti-NMDAR-EN, (MNOS).” 19 , 51 In our literature review, we captured a total of 200 patients who either met the diagnostic criteria for autoimmune encephalitis and were simultaneously seropositive for both anti-NMDAR-IgG, and MOG-IgG or who met the diagnostic criteria for each of MOG-associated encephalitis (MOGAD-EN) or anti-NMDAR-EN and was seropositive for the antibody associated with the other one, at the same time. 10 Given the rarity of both MOGAD and anti-NMDAR-EN, the co-occurrence of these two entities may happen in the context of an association or could be just a coincidence.…”

“…This overlap could be categorized as one of the following chronological phenotypes: (1) cases that start with a presentation of anti-NMDAR-EN who develop demyelinating events consistent with MOGAD later; (2) cases with a known diagnosis of MOGAD who later present with anti-NMDAR-EN; and (3) cases of autoimmune encephalitis with concurrent positive MOG-IgG and anti-NMDAR-IgG, demonstrating that antibodies against NMDAR and MOG can be simultaneously detected in one patient. 10 , 54 One possible explanation could be an immunological activation (e.g. an infection) driving the production of different subclasses of neuronal autoantibodies (anti-MOG-IgG, anti-NMDAR-IgG), resulting in the development of two different diseases.…”

“…an infection) driving the production of different subclasses of neuronal autoantibodies (anti-MOG-IgG, anti-NMDAR-IgG), resulting in the development of two different diseases. 13 , 53 Another hypothesis is that since both MOG and NMDAR are expressed on oligodendrocytes, an immune attack against one may provoke targeting the other one by antigen spreading. 22 …”

“… 13 , 53 Another hypothesis is that since both MOG and NMDAR are expressed on oligodendrocytes, an immune attack against one may provoke targeting the other one by antigen spreading. 22 …”