SARS-CoV-2-related Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease: A Case Report and Literature Review

Abstract

We herein report a case of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old woman developed unilateral optic neuritis 3 weeks after contracting coronavirus disease 2019 (COVID-19), followed by intracranial demyelinating lesions and myelitis. Since serum anti-MOG antibody was positive, we diagnosed MOG antibody-associated disease. Immunotherapy with steroids resulted in the rapid improvement of neurological symptoms. This is a suggestive case, as there are no reports of MOG antibody-associated disease with multiple neurological lesions occurring after COVID-19. The response to immunotherapy was favorable. This case suggests that it is important to measure anti-MOG antibodies in patients who develop inflammatory neurological disease after COVID-19.

Keywords: COVID-19; MOG antibody-associated disease; SARS-CoV-2; demyelinating autoimmune disease; myelitis; optic neuritis.

Figure 1.

Ophthalmologic findings and brain CT images. A fundus examination revealed redness of the left optic nerve papilla (A) and GP showed a decreased sensitivity around the central area in her left eye (B) (L: left side, R: right side). Brain CT showed mild swelling of the left optic nerve compared to the right (arrowhead) (C).

Figure 2.

Brain MRI. Brain MRI on admission showed that the swelling of the left optic neuritis observed on CT had already improved (A). Brain MRI showed faint T2 high-signal lesions (arrowheads) around the trigone and inferior horn of the left lateral cerebral ventricle, near the ventricular wall above the right ventricular trigone, and in the bilateral subcortical frontal lobes. There were also scattered small T2 high-signal lesions (arrowheads) in the cerebral white matter (B-G). Contrast-enhanced MRI showed a linear enhancement area at the limbus of the lesion in the right superior frontal gyrus (H).

Figure 3.

Spinal cord MRI. Spinal cord MRI showed scattered mottled or linear T2 high-signal lesions (arrowheads) at the C4-C5, C5-C6, Th3-Th4, Th6-Th7, and Th11-12 levels (A, B). Each lesion (arrowheads) had a faint contrast effect (C, D).