Sean Montgomery1, Scott Belliston2
1Neurology, University of North Dakota, 2Sanford
Objective:
We present a case of a 53-year-old female found to have MOGAD who presented 21 years after experiencing an initial attack of transverse myelitis.
Background:
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has been recognized as a distinct clinical entity in adults since around 20121. Still, its natural history and course has yet to be fully understood. About 50% of cases demonstrate a monophasic course while the remaining 50% of cases demonstrate a relapsing course. A recent study by Deschamps et al. (2024) has suggested that the median time from onset to the second attack is about 3.2 months with the longest amount of time reported from onset to second attack being 86.2 months2.
Results:
In 2003, our patient experienced decreased sensation from the level of her mid chest down with coinciding urinary retention. She was found to have transverse myelitis at that time and underwent treatment with steroids with subsequent resolution. She followed with neurology for the next several years, undergoing serial imaging without any progression of disease. She continued to remain asymptomatic until 21 years later when she presented to our facility with mild, persistent paresthesias and intermittent double vision. Imaging demonstrated new T2 hyperintensities of the left lateral medulla, right paramedian pons, cervical spinal cord, and thoracic spinal cord. Given mild symptoms, plan was to follow-up in the neurology clinic within 2 weeks. MOG IgG antibodies returned positive (1:100) after her discharge but she presented 7 days later with clinical and radiographic worsening. She then underwent treatment with steroids and plasma exchange with eventual symptom resolution within 3 months.
Conclusions:
This case suggests that MOGAD relapses can occur many more years after onset than what was previously thought and should still remain high on the differential diagnosis even in patients who have gone many years between clinical attacks.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.