Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis and myelitis in COVID-19: a case report and a review of the literature

Abstract

Background: Our case explored the spectrum of autoimmune and infectious neurological complications of Coronavirus Disease 2019. In addition, we also reviewed and discussed clinical features, neuroimaging, CSF findings, and outcomes in patients with COVID-19-associated Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD) CNS inflammatory disorder.

Case presentation: Here we presented a case of post-Coronavirus Disease 2019 infection Myelin Oligodendrocyte Glycoprotein Antibody Disorder in a 41-year-old male who presented with gait instability, urinary retention, and confusion. Workup done in hospital showed transverse myelitis in cervical spine region and left optic neuritis. Laboratory findings showed Myelin Oligodendrocyte Glycoprotein-IgG antibodies were positive in serum (1:100), suggestive of post-COVID Myelin Oligodendrocyte Glycoprotein Antibody Disorder.

Conclusion: To our knowledge, this is the first comprehensive case report and the literature review that includes the clinical features, neuroimaging, CSF findings, and outcomes in COVID-19-associated Myelin Oligodendrocyte Glycoprotein Antibody Disorder.

Keywords: COVID-19; CSF; MOG; MRI in COVID-19; Myelitis; Optic neuritis; SARS-CoV-2.

Fig. 1

MRI sagittal STIR images (A) of the cervical spine reveal ill-defined long segment hyperintensity with prominent cord expansion C2–C4 (red arrow); B shows axial cut with cord signal alteration at C3 (red arrow), and C post-contrast sagittal image showed no abnormal enhancement. MRI orbit Axial T1-weighted fat suppression post-contrast (D) and coronal images (E) reveals abnormal enhancement of left optic nerve pre-chiasmatic (intracanicular); (yellow arrow) with corresponding hyperintense on axial T2 weighted images (F) (yellow arrow) with no abnormality of the right optic nerve (blue arrow)