MOG-IgG as a marker of acute disseminated encephalomyelitis
Clinical cases: Neurology
Background
A 47-year-old man presents with an upper respiratory tract infection. Within two weeks, he develops headaches, eye pain, and numbness, and progresses to a coma (ventilator-dependent). He is unable to move his arms and legs (quadriplegia). The patient receives an MRI of the head and spine, which is abnormal. Cerebrospinal fluid (CSF) shows inflammation and negative AQP4-IgG. A brain biopsy reveals acute disseminated encephalomyelitis (ADEM). MOG-IgG is tested and is positive. The patient is treated with steroids and recovers.
Upon retest six months later, the patient is still positive for MOG antibodies. He develops optic neuritis episodes and is placed on long-term treatment with mycophenolate.
Teaching points
- MOG-IgG is a marker of ADEM.
- Testing may help avoid brain biopsy.
- High titer predicts greater risk of relapse.
- Persistence of MOG-IgG upon repeat testing may help predict the likelihood of recurrence and the need for maintenance treatment.
Learn more about our CNS demyelinating disease testing through this case study focused on MOG-IgG as a marker of acute disseminated encephalomyelitis.
