Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct CNS inflammatory disease with symptoms and imaging findings that overlap with other neuroinflammatory disorders. We reported a 12-year-old girl with no known medical illness presented with gradually worsening blurring vision, and nearly blindness, associated with headache with a pain score of 2-5/10. The blurring vision started 1 week ago, initially over the right eye, then the left eye 3 days later, and subsequently, visual loss bilaterally. On examination, the pupil is 6 mm but has no perception of light. On fundoscopy, noted in both eyes: swelling, elevated, blurred margin, pink, dilated tortuous blood vessels, normal fovea reflex, no macula star, also no vitiritis or retinitis. The CNS examination is unremarkable. The patient then underwent a CT scan of the brain showed apart from right mastoiditis, no significant abnormality was detected in the brain parenchyma. Noted C3/C4 levels were normal; T4/TSH levels were normal, and ESR was 62 (raised). Since the CT brain finding was normal, we proceeded with an MRI of the brain, which showed leptomeningeal enhancement. Both retrobulbar intra-orbital segments of optic nerves appear symmetrical and swollen until the intracranial compartment just before the optic chiasm with enhancement is observed post-gadolinium. Both optic discs are also bulging in keeping with papilloedema. Both intra-orbital fats were streaky. The patient then had a lumbar puncture, and the result was normal. Serum aquaporin 4 is negative; however, the MOG antibody is detected. The patient was diagnosed with Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and was given intravenous immunoglobulin (IVIg) for 5 days and steroids. Upon discharge, the patient's vision improves by up to 80%. Other differentials could be neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS). It is important to get a correct and early diagnosis of MOGAD because the prognosis and treatment for MOGAD are different from those for NMOSD and MS.
SPR 2023 Annual Meeting & Postgraduate Course
W Mustapha Wan Irfan