MOG antibody-associated encephalitis secondary to Covid-19: case report

Abstract

Background While Covid-19 predominantly affects the respiratory system, neurological manifestations including encephalitis occur in some patients, possibly affecting the course and outcome of the disease. Here, we describe a unique case of a young man with Covid-19 and transient MOG-positive encephalitis, with a benign course. Case presentation A 22-year-old male, with PCR confirmed Covid-19 infection was admitted because of persistent headache. The clinical examination was normal. Neuropsychological testing revealed distinct executive deficits. Brain MRI and cerebrospinal fluid (CSF) analysis were suggestive for encephalitis. Further laboratory examination revealed a serum MOG antibody titre. The headache improved with analgetic treatment and i.v. methylprednisolone. Consequently, the MOG antibody titer decreased and MRI lesions were resolving. The patient made a full recovery, with no signs of deterioration over the following months. Conclusions Covid-19 manifestations in the CNS include encephalitis with variable course and prognosis. This case highlights a possible association between inflammation due to COVID-19 and transient secondary autoimmunity with transient MOG antibodies and atypical clinical presentation.

Neuroinflammatory Disease following Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children

“…MOG-associated disorder (MOG-AD) is a distinct demyelinating disorder with a phenotype and an outcome different from that of multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD). Twelve cases of MOGAD have been associated with COVID-19 in the literature, mostly in adult males (8/12) with optic neuritis or encephalomyelitis [ [7] , [8] , [9] , [10] , [11] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. Our case series confirms that the onset of MOGAD can be triggered by SARS-CoV-2 infection and that 16% (3/19) of children with a neuro-inflammatory disease triggered by SARS-CoV-2 had MOG antibodies.…”

“…Severe inflammatory central nervous system (CNS) events, such as encephalitis, acute disseminated encephalomyelitis (ADEM), optic neuritis are rare, but have also been reported in case reports or small series of cases[ 5 , 6 ]. there are case reports of positive MOG (myelin-oligodendrocyte) antibodies (9 adults and 3 children with encephalomyelitis or optic neuritis)[ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ].…”

Myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD) following SARS-CoV-2 infection: A case series

“…Latency period from SARS-CoV-2 infection to development of neurological symptoms ranged from several days to weeks, with generally good recovery and no clinical/radiologic relapses over limited follow-up periods ranging from several days to 2 months ( Table 2 ) . ( Durovic et al, 2021 ; Kogure et al, 2021 ; Peters et al, 2021 ; Sawalha et al, 2020 ; Zhou et al, 2020 ).…”

“… Case report Age (years)/ Gender Comorbidities SARS-CoV-2 Severity ⁎ Latency ⁎⁎ Neurological presentation MRI findings CSF findings MOG-IgG Treatment Outcome Relapsing course? Follow-up time Zhou et al, 2020 26/ Male None Non-severe 2 days Bilateral ON; acute myelitis Bilateral optic nerve enhancement (globe to pre-chiasm); patchy contrast-enhancing hyperintensities in lower cervical and upper thoracic spinal cord WBC 55 cells/mm 3 , protein 31 mg/dL, glucose 57 mg/dL, no unique OCBs 1:1000 † IVMP for 5 days, oral prednisone taper Partial recovery (residual 20/30 VA bilaterally) No 3 weeks Sawalha et al, 2020 44/ Male None Non-severe 14 days Bilateral ON Bilateral optic nerve enhancement (pre-chiasmal) WBC 3 cells/mm 3 , protein 50 mg/dL, glucose 88 mg/dL, OCBs absent 1:160 § IVMP for 5 days, oral prednisone taper Near-complete recovery (right eye impaired VA) No 5 days Kogure et al, 2021 47/ Male Right adrenal resection; recurrent sinusitis Non-severe 2 days Left ON Bilateral (left>right) optic nerve contrast enhancement Reportedly normal WBC, protein, SARS-CoV-2 PCR negative 1:128 § IVMP for 3 days Partial recovery (left eye residual VA 20/160) No 2 weeks Durovic et al, 2021 22/ Male None Non-severe 3 days Meningism Cortical T2 hyperintensities without contrast enhancement WBC 31 cells/mm 3 , protein 40 mg/dL, glucose 64 mg/dL, SARS-CoV-2 PCR negative …”

Myelin Oligodendrocyte Glycoprotein-Associated Disorders Post-ChAdOx1 Vaccination

“…MOGAD has been reported with coronavirus disease 2019 (COVID-19) as a para-or post-infection [5][6][7][8]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is thought to elicit a host autoimmune response that precipitates MOGAD.…”