Influenza-associated MOG antibody-positive longitudinally extensive transverse myelitis: a case report

Abstract

BackgroundMyelin-oligodendrocyte glycoprotein antibody (MOG antibodies) was found in various demyelinated diseases. This is the first report of a patient with longitudinally extensive transverse myelitis with an extremely high titer of MOG antibodies after an influenza infection. This case supports the view that MOG antibodies are linked to longitudinally extensive transverse myelitis and that influenza infection might trigger the MOG antibodies.Case presentationA 32-year-old healthy male developed high fever, dysesthesia and paraesthesia below the C2 area, muscle weakness of the bilateral lower extremities, and urinary retention ten days after an influenza type A infection. Magnetic resonance imaging revealed a longitudinal lesion in the spinal cord extending from C2 to the spinal conus. There were no lesions in the brain or optic nerves. Established cell-based immunoassays revealed that he was positive for MOG antibodies (titer = 65,536) and negative for anti-aquaporin 4 antibodies (AQP4 antibodies). He fully recovered after steroid pulse therapy followed by 60 mg prednisolone.ConclusionThis is the first report of influenza A-associated longitudinally extensive transverse myelitis with a high titer anti-MOG antibodies. Our case report supports a relationship between anti-MOG antibodies and longitudinally extensive transverse myelitis, which was triggered by influenza infection. Further studies are needed to establish the clinical significance of anti-MOG antibodies for diagnosis, treatment, and prognosis.

Anti-myelin Oligodendrocyte Glycoprotein Antibodies in a Patient with Recurrent Optic Neuritis Involving the Cerebral White Matter and Brainstem

“…Our case supports this observation. Amano et al reported a case of influenzaassociated transverse myelitis in a patient positive for MOG antibodies and considered influenza infection as a possible trigger for myelitis (9). Considering that the anti-MOG antibody titers in our patient were the same before and after the brain MRI abnormalities developed, the combination of anti-MOG antibodies and an external trigger may have led to brain MRI abnormalities.…”

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

“…Post‐infectious ADEM and transverse myelitis are thought to represent an autoimmune process triggered by the infection that is hypothesized to share antigentic features with antibodies directed at myelin proteins. One patient with influenza‐associated transverse myelitis was found to have high titers of myelin oligodendrocyte glycoprotein antibodies, suggesting a pathogenic role . Additionally, one patient had recurrent ADEM after a second influenza infection 6 months after his first episode and another had recurrent ADEM after an influenza vaccination suggesting a role for genetic predisposition or formation of an immunologic mechanism …”

“…121 One patient with influenza-associated transverse myelitis was found to have high titers of myelin oligodendrocyte glycoprotein antibodies, suggesting a pathogenic role. 137 Additionally, one patient had recurrent ADEM after a second influenza infection 6 months after his first episode and another had recurrent ADEM after an influenza vaccination suggesting a role for genetic predisposition or formation of an immunologic mechanism. 132,135…”

Autoimmune and Paraneoplastic Myelopathies

“…67 Presumed parainfectious/postinfectious inflammatory myelopathies have been reported in association with a variety of viral and bacterial triggers, but a definitive inflammatory etiology and correlation with infection is often difficult to prove, and infections are also well-established triggers of other definable inflammatory myelopathies such as MS, 15 AQP4-IgG seropositive NMOSD, 68 and MOG-IgG CNS demyelinating disease. [69][70][71] Fig . 2 Imaging findings in mimickers of inflammatory myelopathies.…”