Isolated Double-Positive Optic Neuritis: A Case of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Seropositivity

Mason, Matthew; Marotta, Dario A; Kesserwani, Hassan

doi:10.7759/cureus.15389

Cited by 5 publications

(5 citation statements)

References 17 publications

(15 reference statements)

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“…Fifty-three relevant studies were identified after title and abstract screening. After reading the full texts and reviewing the references of the retrieved articles, 35 studies were finally included in the qualitative synthesis, of which 14 were retrospective studies [ 11 , 15 , 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] and 21 were case reports [ 12 , 13 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. A total of 113 patients (46 males and 67 females) were reported to show the coexistence of MOG-IgG and neuronal or glial antibodies in these 35 studies.…”

Section: Resultsmentioning

confidence: 99%

Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review

et al. 2022

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Background: Myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) has been considered a diagnostic marker for patients with demyelinating disease, termed “MOG-IgG associated disorder” (MOGAD). Recently, the coexistence of MOG-IgG and other neuronal or glial antibodies has attracted extensive attention from clinicians. In this article, we systematically review the characteristics of MOG-IgG-related antibody coexistence syndrome. Methods: Two authors independently searched PubMed for relevant studies published before October 2021. We also manually searched the references of each related article. The appropriateness of the included studies was assessed by reading the titles, abstracts, and full texts if necessary. Results: Thirty-five relevant publications that met our inclusion criteria were finally included, of which fourteen were retrospective studies and twenty-one were case reports. A total of 113 patients were reported to show the coexistence of MOG-IgG and neuronal or glial antibodies. Additionally, 68.14% of patients were double positive for MOG-IgG and N-Methyl-D-Aspartate Receptor-IgG (NMDAR-IgG), followed by 23.01% of patients who were double positive for MOG-IgG and aquaporin4-IgG (AQP4-IgG). Encephalitis was the predominant phenotype when MOG-IgG coexisted with NMDAR-IgG, probably accompanied by imaging features of demyelination. Patients with dual positivity for MOG-IgG and AQP4-IgG experienced more severe disease and more frequent relapses. The coexistence of MOG-IgG and antibodies other than NMDAR-IgG and AQP4-IgG was extremely rare, and the clinical presentations were diverse and atypical. Except for patients who were double positive for MOG-IgG and AQP4-IgG, most patients with multiple antibodies had a good prognosis. Conclusions: MOG-IgG may coexist with neuronal or glial antibodies. Expanded screening for neuronal or glial antibodies should be performed in patients with atypical clinical and radiological features.

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Section: Resultsmentioning

confidence: 99%

Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review

et al. 2022

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“… 68 , 75 Given the overall rarity of double positive cases based on the results of the larger studies, and considering the superior specificity of the AQP4-IgG test compared to the MOG-IgG test, and that a reliable cell-based-assay (CBA) for detecting MOG-IgG has been available just recently (2017), there is a high possibility that most of the double positive cases may likely be AQP4-IgG + NMOSD with false positive MOG-IgG test results, especially in reports made before this time with using enzyme-linked immunosorbent assay (ELISA). 68 , 75 …”

Section: Discussionmentioning

confidence: 99%

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

Molazadeh

Bose

Lotan

et al. 2022

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has various similarities with AQP4-IgG-seropositive Neuromyelitis Optica Spectrum Disorder (AQP4-IgG + NMOSD) in terms of clinical presentations, magnetic resonance imaging (MRI) findings, and response to treatment. But unlike AQP4-IgG + NMOSD, which is known to coexist with various autoimmune diseases and cancers, an association of MOGAD with these conditions is less clear. Methods We conducted a systematic search in PubMed, Scopus, Web of Science, and Embase based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Duplicates were removed using Mendeley 1.19.8 (USA production) and the citations were uploaded into Covidence systematic review platform for screening. Results The most common autoimmune disease overlapping with MOGAD was anti-N-Methyl-D-Aspartate receptor encephalitis (anti-NMDAR-EN), followed by autoimmune thyroid disorders, and the most common autoantibody was antinuclear antibody (ANA), followed by AQP4-IgG (double-positive MOG-IgG and AQP4-IgG). A few sporadic cases of cancers and MOG-IgG-associated paraneoplastic encephalomyelitis were found. Conclusion Unlike AQP4-IgG + NMOSD, MOGAD lacks clustering of autoimmune diseases and autoantibodies associated with systemic and organ-specific autoimmunity. Other than anti-NMDAR-EN and perhaps AQP4-IgG + NMOSD, the evidence thus far does not support the need for routine screening of overlapping autoimmunity and neoplasms in patients with MOGAD.

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“…There have been a few reported literature showing double-seropositive (MOG-positive and AQP4-positive) optic neuritis and myelitis. 2,3 Double-positive NMOSD is found to have a high relapse rate and residual disability with MRI of the brain showing MS-like brain lesions in two-thirds of patients, while MRI of the spine showing edematous spinal cord from cervical to conus region. 2 APS at onset can delay the diagnosis of NMOSD causing further neurologic deficits in the form of optic neuritis, transverse myelitis, or brainstem syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Double seropositivity in NMOSD has been rarely reported in literature. 2,3 We report a rare case of APS as an initial presentation of double-seropositive AQP4 and MOG antibodies.…”

mentioning

confidence: 96%

Area Postrema Syndrome

et al. 2022

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Abstract:Objectives:Area postrema syndrome (APS) is one of the core clinical feature of neuromyelitis optic spectrum disorder (NMOSD). APS is mostly associated with neuromyelitis optica (NMO) and rarely reported in myelin oligodendrocyte glycoprotein antibody disease (MOGAD). We herein report a case of area postrema syndrome as the initial presentation of double seropositive aquaporin-4 (AQP-4) and myelin oligodendrocyte glycoprotein (MOG)antibody.Methods:The patient fulfilled the NMOSD diagnostic criteria. MRI brain, CSF studies, electrophysiological test and serum NMO and MOG antibody testing were done.Results:An elderly female initially presented in Gastroenterology outpatient department with a history of nausea, vomiting and hiccups for 3 weeks. Detailed medical evaluation including upper gastrointestinal endoscopy was normal with no improvement with symptomatic therapy. Neurological examination showed bilateral nystagmus, postural imbalance and gait ataxia. MRI brain showed T2/FLAIR hyperintensity in dorsal medulla involving area postrema. Both anti NMO and MOG antibodies were found to be positive in serum. She was treated with intravenous methyl prednisolone with complete symptomatic resolution.Discussion:Double seropositive APS-onset NMOSD has not been previously reported in literature. Early diagnosis and treatment results in resolution of APS- related symptoms and prevents further progression of disease.

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Isolated Double-Positive Optic Neuritis: A Case of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Seropositivity

Cited by 5 publications

References 17 publications

Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review

Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review

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

Area Postrema Syndrome

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