Case Report: Overlapping Syndrome of Anti-NMDAR Encephalitis and MOG Inflammatory Demyelinating Disease in a Patient With Human Herpesviruses 7 Infection

Abstract

ObjectivesThis study reported a case of overlapping anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and myelin oligodendrocyte glycoprotein (MOG) inflammatory demyelinating disease with human herpesviruses 7 (HHV-7) infection.MethodsThe detailed clinical characteristics, neuroimaging features, and outcomes of the patient were collected. Polymerase chain reaction (PCR), cell-based assay (CBA) and the tissue-based indirect immunofluorescence assay (TBA) were used for diagnosis.ResultsThe clinical manifestations included headache, dizziness, fever, optic neuritis, and epileptic-seizures. Brain magnetic resonance imaging (MRI) showed hyperintensities involving the left frontal, orbital gyrus and bilateral optic nerve with substantial contrast enhancement. Moreover, test for HHV-7 DNA by using the next generation sequencing metagenomics and polymerase chain reaction showed positive result in CSF but not in the serum samples. Anti-HHV-7 IgM and IgG antibodies were detected in both the serum and cerebrospinal fluid. NMDAR antibodies (1:10) were found positive in the patient’s CSF by a cell-based assay, and MOG antibodies were positive in the serum (1:10) and CSF (1:32). The patient appeared to respond well to immune therapy and it was found that the clinical symptoms including epileptic-seizure as well as headache were relieved and cerebral lesions almost disappeared after the treatment. However, his vision was not completely restored even at the 8-month follow-up, especially the vision in his right eye which was more seriously damaged.DiscussionWe report a rare case of MOG antibodies and anti-NMDAR encephalitis overlapping syndrome (MNOS) with HHV-7 infection for the first time. The possibility of MNOS needs be considered when optic neuritis occurs in the patients diagnosed with anti-NMDAR encephalitis. Besides, immunotherapy should be initiated as early as possible to improve the treatment outcomes and facilitate complete cure.

Case report: Overlapping syndrome mimicking infectious meningoencephalitis in a patient with coexistent MOG, NMDAR, mGluR5 antibody positivity

“…The immune cells may attack the antigens of MOG and NMDAR when targeting oligodendrocytes, and subsequent generate corresponding antibodies in CSF and serum (8). Indeed, several cases have recently reported the co-occurrence of antibodies against both MOG and NMDAR (9)(10)(11). Hence, a new emerging concept referring to the coexistence of anti-MOG and anti-NMDAR antibodies is called MOGAD and anti-NMDAR encephalitis overlapping syndrome (MNOS) (11).…”

Human herpesvirus 7 encephalitis in an immunocompetent adult and a literature review

“…Patients' ages ranged from 26 to 52, with a median of 35 years and only one female. The mortality was 14.2%, and ganciclovir was given to 6 patients [4][5][6][7][8][9]. Ganciclovir and foscarnet were recommended in immunocompromised patients with HHV-6 infection [10], but the treatment of encephalitis associated with the human herpesvirus-7 infection is still limited and unclear.…”

Overlapping anti-NMDAR encephalitis and multiple sclerosis: A case report and literature review

“…Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common autoimmune-mediated encephalitis characterized by the manifestation of abnormal behavior, psychosis, seizures, abnormal movement, insomnia, and irritability ( 1 ). A few studies reported anti-NMDAR encephalitis overlapping with neuromyelitis optica spectrum disorders, acute demyelinating encephalomyelitis, and myelin oligodendrocyte glycoprotein (MOG) inflammatory demyelinating disease ( 2 , 3 ). Nevertheless, anti-NMDAR encephalitis associated with multiple sclerosis (MS) is rare.…”