Objective:

To report a rare case of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) presenting with optic neuritis and central retinal vein occlusion (CRVO).

Background:

Optic neuritis is the most common presentation of MOGAD. It classically presents as an acute or subacute, unilateral, painful vision loss, with exam showing relative afferent pupillary defect. CRVO can have a similar clinical presentation to optic neuritis, however, CRVO is not usually associated with optic neuritis nor MOGAD.

Design/Methods:

N/A

Results:

A 64 year-old man with history of hypertension, diabetes, and ocular migraines presented with 10 days of progressive right eye vision loss and headache. Fundoscopic exam was notable for grade 4 disc edema and significant burden of dot blot hemorrhages in all quadrants of the right eye. Intravenous fluorescein angiography demonstrated delayed arterial and venous filling and transit time consistent with CRVO. MRI brain and orbits showed enhancement of the posterior portion of the right optic nerve extending into the intracanalicular area, and an enhancing lesion involving the right middle cerebellar peduncle and right anterolateral pons. CSF was notable for mildly elevated protein without pleocytosis. Serum laboratory workup was positive for MOG IgG antibody with a titer of 1:100. MRI spine, and CT chest/abdomen/pelvis were nonrevealing. The rest of serum and CSF analysis including comprehensive infectious, inflammatory and autoimmune panels were all unremarkable. The patient was diagnosed with MOGAD, and he was treated with high dose intravenous methylprednisolone and plasmapheresis. Upon follow up in clinic, his vision has improved, and repeat MOG titer was negative. He was started on Rituxan for maintenance treatment.

Conclusions:

MOGAD optic neuritis can result in CRVO. In the appropriate clinical context, a diagnosis of MOGAD should be considered in patients presenting with CRVO, and the proper neuro-imaging and laboratory testing should be ordered.