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Review
. 2025 Sep;46(9):4269-4278.
doi: 10.1007/s10072-025-08231-6. Epub 2025 Jun 5.

Acute bilateral optic/chiasm neuritis with longitudinally extensive transverse myelitis and positive anti-ganglioside antibodies following mycoplasma pneumoniae pneumonia: a case report and literature review

Juan Zhao  1 , Nan Jia  1 , Jiabao Zhao  1 , Jiawei Wang  1 , Liping Zhu  2
Affiliations
Review

Acute bilateral optic/chiasm neuritis with longitudinally extensive transverse myelitis and positive anti-ganglioside antibodies following mycoplasma pneumoniae pneumonia: a case report and literature review

Juan Zhao et al. Neurol Sci. 2025 Sep.

Abstract

Background: We present a case of a patient diagnosed with optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM) following Mycoplasma pneumoniae (M.pneumoniae) pneumonia.

Methods: A 60-year-old male, 16 days post-M.pneumoniae pneumonia, was evaluated for vision loss-no light perception in the right eye and perceiving only finger movements at a distance of 20 cm in the left. He also exhibited paraparesis, absent tendon reflexes in the lower limbs, urinary incontinence, and sensory deficits below the left L1 and right T10 dermatomes. Clinical data were collected, followed by a literature review of case reports from the 1990s to the present.

Results: Serum testing showed positive IgG antibodies against GM1 and GD1b, while cerebrospinal fluid (CSF) was negative for these antibodies. CSF analysis indicated mild pleocytosis and slight protein elevation, with negative PCR for M.pneumoniae. Cranial MRI identified contrast-enhanced lesions in the left occipital lobe, the optic nerve, optic chiasm, and adjacent tracts, while spinal MRI revealed multiple intramedullary lesions at C2-C4, T4-T7, and T10-T11 levels. Nerve conduction studies were normal. The patient received treatment with intravenous immunoglobulin, corticosteroids, and moxifloxacin, leading to a significant improvement in myelitic symptoms and partial recovery of visual function. The literature review indicated ten cases of isolated ON, nineteen with isolated acute myelitis, and five with concomitant ON and myelitis.

Conclusion: MOG-like ON, either occurring in isolation or in conjunction with LETM (i.e.NMOSD-like), is a rare complication following M.pneumoniae infection. Immune-mediated mechanisms may significantly contribute to its pathogenesis.

Keywords: Ganglioside antibodies; Mycoplasma pneumoniae; Myelitis; Optic chiasm; Optic neuritis.

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Conflict of interest statement

Declarations. Ethical approval: Ethical approval was waived by the local Ethics Committee of Beijing Tongren Hospital, Capital Medical University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Consent to publish: The patient has consented to the submission of the case report to the journal. Informed consent: Written informed consent was obtained from the patient. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

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