MOGAD Presenting as Optic Neuritis

A report describes a case of a five-year-old, developmentally normal girl who presented with fever and headache (right-sided) for four days’ duration and a single episode of right-sided focal seizure with secondary generalization enduring for 15-20 minutes on the day of presentation.

There wasnt any history of trauma, vomiting, weakness of any limb, altered sensorium, or ear discharge. 

Examination revealed the child to be conscious, with normal blood pressure. Her neurological examination (including fundoscopy) was unremarkable. Her history and cerebrospinal fluid examination prompted a diagnosis of septic meningitis, and the patient received systemic antibiotics and anticonvulsants. 

One week post-discharge, she reported a recurrence of headache, along with pain and deviation of the right eye. Examination showed right eye lateral rectus palsy. Her Visual acuity was noted as 6/36 (right eye) and 6/6 (left eye), with intact field of vision, color vision, and pupillary and light reflexes. Right disc edema was confirmed with fundoscopy. Her intraocular pressure (IOP) was normal. Magnetic resonance imaging (MRI) of the brain showed hyperintensities in bilateral optic nerves (right>left) with patchy T2/FLAIR hyperintensities in pons, left frontal, bilateral parietal, and right temporal white matter. Hence, Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disorder (MOGAD) was considered and confirmed on serology. The patient received Intravenous methylprednisolone (30 mg/kg/dose for five days) followed by oral prednisolone (2 mg/kg/d for one month and tapering doses for the next one month) which caused complete recovery recovered. The child was doing well after three months of follow-up.

Shrivastava A, Tandon M, Yadav RK, et al. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disorder (MOGAD) Presenting as Optic Neuritis: A Case Series. Indian Pediatrics. 2024;61