Postinfectious Acute Disseminated Encephalomyelitis Associated With Antimyelin Oligodendrocyte Glycoprotein Antibody

Abstract

Myelin oligodendrocyte glycoprotein is a major target of the humoral immune response in children affected by inflammatory demyelinating diseases of the central nervous system. Although myelin oligodendrocyte glycoprotein causes autoimmune encephalitis in different animal models, the relevance of this mechanism in human autoimmune diseases of the central nervous system is unclear. We herein report a child with acute disseminated encephalomyelitis possibly triggered by central nervous system infection of primary herpes simplex virus in the presence of antimyelin oligodendrocyte glycoprotein antibody. A healthy 5-year-old Japanese boy suffered from acute disseminated encephalomyelitis. He was positive for antimyelin oligodendrocyte glycoprotein antibody in both the serum and the cerebrospinal fluid, and herpes simplex virus-1 DNA on polymerase chain reaction of the cerebrospinal fluid. We speculated that the central nervous system infection of primary herpes simplex virus disrupted the blood-brain barrier, and antimyelin oligodendrocyte glycoprotein antibody already present in serum was transferred to the cerebrospinal fluid, resulting in the onset of acute disseminated encephalomyelitis. This might be the mechanism underlying postinfectious acute disseminated encephalomyelitis associated with myelin oligodendrocyte glycoprotein antibody.

Keywords: acute disseminated encephalomyelitis; antimyelin oligodendrocyte glycoprotein antibodies; herpes simplex virus infection.

Figure 1.

Clinical course of the therapy, symptoms, and laboratory data. This graph illustrates the therapy course, the patient’s symptoms, and the laboratory data. ABPC indicates ampicillin; ACV, acyclovir; CSF, cerebrospinal fluid; CTRX, ceftriaxone; HSV, herpes simplex virus; IVIG, intravenous immunoglobulin; MOG, myelin oligodendrocyte glycoprotein; mPSL, methylprednisolone; MRI, magnetic resonance imaging; PSL, prednisolone.

Figure 2.

A, Brain MRI findings in day 8 after the onset. The images showed multifocal high-intensity lesions on corresponding axial T2-weighted imaging, fluid-attenuated inversion recovery imaging, and diffusion-weighted imaging, and a low-intensity lesion on corresponding apparent diffusion coefficient map. B, Spinal MRI findings in day 13 after the onset. The image showed a high-intensity lesion (arrow) in the cervical spinal cord on T2-weighted imaging. A indicates anterior; ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery imaging; L, left; MRI, magnetic resonance imaging; P, posterior; R, right; T2WI, T2-weighted imaging.