Myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) is an acute demyelinating disorder with heterogeneous clinical and imaging presentations. The aim of this abstract is to describe a case of MOGAD with extensive radiological findings resembling leukodystrophy, which is rarely reported.
An 8-year-old girl presented to us with the first episode of acute onset of slurred speech and left-sided upper and lower limb weakness. Examination generalized hypotonia and hyporeflexia, more pronounced on the left side, with mouth deviation to the right. Cerebrospinal fluid analysis was normal except for mild pleocytosis (WBC: 7 × 106 cells). Stroke work-up was unremarkable. Brain MRI showed bilateral asymmetrical supratentorial white matter areas of altered signal, involving the right fronto-temporo-parietal and left fronto-parieto-occipital regions, along subcortical distribution. Brain MRA and MRV were essentially normal. Serum analysis revealed a positive result for MOG-IgG ( Titer: 1:160). Other autoantibodies, including anti-aquaporin 4 and oligoclonal bands, were normal. The patient received IVIG followed by pulse steroid and oral prednisolone. Upon tapering prednisolone, she experienced a relapse attack of optic neuritis and was started on rituximab, with a favorable prognosis.
The clinical and radiological phenotype of MOGAD is broad, which could have a role in treatment and prognosis. Our case had an uncommon acute weakness with widespread changes in the white matter, overlapping with radiological findings of leukodystrophies, with a relapse while on treatment requiring the use of immunosuppressants.
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To date, few cases of leukodystrophy-like patterns have been reported in MOGAD. Further research is needed to establish the diagnostic criteria and the impact of these radiological findings on prognosis prediction with subcortical distribution.