Anti-NMDAR autoimmune encephalitis following mog-antibody-positive optic neuritis: A rare case report
Main Article Content
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) autoimmune encephalitis may occur after Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) in children. This case report describes a rare progression from myelin oligodendrocyte glycoprotein antibody (MOG) optic neuritis to anti-N-methyl-d-aspartate receptor (NMDAR) autoimmune encephalitis in a 6-year-old girl from Vietnam. In July 2024, the patient presented with sudden blurring of vision and was diagnosed with MOG-positive optic neuritis and the patient’s symptoms improved after corticosteroid and immunoglobulin treatment over three months. One month later, the patient returned for treatment due to developed seizures, behavioral changes, speech impairment, and cognitive impairment. Anti-MOG was negative in serum, anti-NMDAR antibodies were detected in the cerebrospinal fluid, and brain magnetic resonance imaging revealed left hippocampal lesions, confirming the diagnosis of anti-NMDAR autoimmune encephalitis. Treatment with high-dose corticosteroids and immunoglobulin led to significant clinical improvement after three months. This case highlights the unique overlap between MOG-antibody disease and anti-NMDAR encephalitis, emphasizing the importance of early diagnosis and treatment in pediatric patients.
Article Details
Keywords
Anti-NMDAR autoimmune encephalitis, optic neuritis, MOGAD, children
References
2. Dalmau J, Armangue T, Planaguma J, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol. 2019;18(11):1045-57. doi: 10.1016/S1474-4422(19)30244-3.
3. Titulaer MJ, Höftberger R, Iizuka T, et al. Overlapping demyelinating syndromes and anti–N-methyl-D-aspartate receptor encephalitis. Ann Neurol. 2014;75(3):411-428. doi:10.1002/ana.24117.
4. Tian Nie, Wan Wei. MOGAD following anti-NMDAR encephalitis: A case report. Neurology Asia. 2023;28(2):459-463. https://doi.org/10.54029/2023nap.
5. Cong Zhao, Pei Liu, Daidi Zhao, et al. Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review. Brain Sci. 2022;12,995. https://doi.org/10.3390/brainsci12080995.
6. Bing-Qing Du, Qi-Lun Lai, Er-Chuang Li, et al. Myelin oligodendrocyte glycoprotein antibody and N-methyl-d-aspartate receptor antibody overlapping syndrome: insights from the recent case reports. Clinical and Experimental Immunology. 2024;215:27-36. https://doi.org/10.1093/cei/uxad109.
7. Tania Cellucci, Heather Van Mater, Francesc Graus, et al. Clinical approach to the diagnosis of autoimmune encephalitis in the pediatric patient. Neurol Neuroimmunol Neuroinflamm. 2020;7:e663. doi:10.1212/NXI.0000000000000663.
8. Margherita Nosadini, Terrence Thomas, Michael Eyre, et al. International Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis. Neurol Neuroimmunol Neuroinflamm. 2021,0;8:e1052. doi:10.1212/NXI.0000000000001052.
9. Liu X, Giri M, Ling W, et al. Optic neuritis associated with anti-NMDA receptor antibody in the remission phase of anti-NMDA receptor encephalitis. Neurol India. 2020;68:474-477.
10. Kunchok A, Flanagan EP, Krecke KN, et al. MOG-IgG1 and co-existence of neuronal autoantibodies. Mult Scler. 2021;27:1175-86. doi:10.1177/1352458520951046.
11. Yijun Ren, Xiqian Chen, Qiang He. Co-occurrence of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Anti-myelin Oligodendrocyte Glycoprotein Inflammatory Demyelinating Diseases: A Clinical Phenomenon to Be Taken Seriously. Front Neurol. 2019;10:1271. doi: 10.3389/fneur.2019.01271.