Objective:

To present a case of two recurrences of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) precipitated by administration of TDaP vaccination. 

Background:

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder of the central nervous system with presence of positive antibodies against the myelin oligodendrocyte protein. MOGAD has been triggered by infections and vaccinations with symptom onset typically 1-2 weeks post infection or inoculation. Vaccinations linked to MOGAD include COVID-19, influenza, TDaP and MMR. To date there has only been relapse of MOGAD after subsequent doses of COVID-19. 

Design/Methods:

An adult male presented to a tertiary medical center for ongoing care after being admitted to local hospitals twice with symptoms of bilateral eye pain and vision loss 2 weeks following administration of Tdap vaccination. Presentations: 11/6/15 (vaccination 10/22/15, 15 days), 9/2/24 (vaccination 8/20/24, 13 days).  

Results:

Initial presentation MRI demonstrated bilateral optic neuritis with reported normal CSF and serum studies. Patient treated with high dose steroids followed by pulse dose steroids for one month with return to normal vision. Second presentation MRI demonstrated bilateral optic neuritis and serum MOG Ab positive with titer of 1:160 and negative serum NMO/AQP4 Ab. Patient was started on high dose steroids followed by maintenance steroids and initiation of steroid sparing therapy. Vision returned to baseline with no additional episodes of eye pain or vision changes.

Conclusions:

We present a case of two recurrences of post Tdap inoculation MOGAD in an adult patient which to date has only been monophasic following Tdap. This would be the first case of multiple flares of MOGAD triggered by a vaccination other than COVID-19 vaccination which suggests the autoimmune response could be triggered by not only T cell mediated molecular mimicry but also alternative mechanisms such as adjuvant-induced immunity from tetanus aluminum-based adjuvants which has been linked with increased immune response.