Uveitis and optic perineuritis in the context of myelin oligodendrocyte glycoprotein antibody seropositivity

Abstract

Background and purpose Antibodies to myelin oligodendrocyte glycoprotein (MOG) have been identified in both children and adults with demyelination, with a strong association with bilateral or recurrent optic neuritis (ON). However, the full clinical spectrum of this newly described condition is unknown. We sought to describe non‐ON inflammatory ophthalmological presentations such as uveitis and optic perineuritis in the context of MOG antibody seropositivity. Methods Using a live cell‐based assay analysed by flow cytometry, we identified seropositive patients referred for MOG antibody testing in Australasia between 2014 and 2017. We identified four MOG antibody‐positive patients with non‐ON inflammatory ophthalmological presentations and present their detailed clinical information in this case series. Results Three patients had uveitis either in association with, or remote from, ON. One patient had optic perineuritis and peripheral ulcerative keratitis. We describe the presentation, examination, investigation findings and clinical course of these four patients. Conclusions Recognition of these novel clinical associations may expand the clinical spectrum of MOG antibody‐associated presentations. An expedited diagnosis may guide the management of these complex patients.

Characterization of the human myelin oligodendrocyte glycoprotein antibody response in demyelination

“…Equivocal patients were re-blinded and independently retested. To avoid bias between assays, and in absence of diagnostic criteria for MOG Ab-associated disorders, sensitivity and specificity were determined using two groups of patients: monophasic and relapsing disorders with reported MOG Ab-association (such as ADEM, ON, BON, LETM) [23, 26, 46, 48, 49, 52, 70], and monophasic and relapsing disorders with not yet reported MOG Ab-association and disorders not associated with MOG Ab (MS, CIS other than ON, and general medical and non-inflammatory neurological disorders) [23, 26, 49, 52, 70].…”

The Expanding Clinical Spectrum of Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Associated Disease in Children and Adults

“…Perineural enhancement is a feature that can help differentiate MOGAD from NMOSD or MS ( 13 , 21 , 25 , 36 , 37 ). Isolated cases of MOGAD perineuritis, involving the nerve sheath and surrounding structures but not the optic nerve, have also been reported ( 38 , 39 ). Rarely, uveitis and keratitis can occur simultaneously or subsequently to MOG-ON ( 38 ).…”

Myelin oligodendrocyte glycoprotein antibody-associated diffuse orbital inflammation

“…3,4 Of note, recently, non-ON inflammatory ophthalmological presentations were reported in four MOG-IgG positive patients: three had uveitis and one had peripheral ulcerative keratitis, in association with or remote from ON. 5…”