Cerebral cortical encephalitis followed by recurrent CNS demyelination in a patient with concomitant anti-MOG and anti-NMDA receptor antibodies

Mult Scler Relat Disord. 2017 Nov;18:90-92. doi: 10.1016/j.msard.2017.09.023. Epub 2017 Sep 22.

Abstract

We report the case of a patient who initially presented with fever, headache and seizure. MRI revealed a fluid attenuation inversion recovery (FLAIR) high-intensity lesion involving the right temporal, parietal and occipital cortex. Afterwards, the patient developed three recurrent episodes, manifested as brainstem encephalitis, optic neuritis and ADEM-like illness successively, indicating demyelination. Both of his serum anti-MOG and CSF anti-NMDAR antibodies were proved positive by transfected cell based assays. We consider our case to have cortical encephalitis due to certain autoimmune mechanism initially, and then developed MOG-antibody mediated recurrent demyelination in the following episodes.

Keywords: Autoimmune encephalitis (AIE); Myelin oligodendrocyte glycoprotein (MOG); N-methyl-D-aspartate receptor (NMDAR).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnostic imaging
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / immunology
  • Autoantibodies / blood*
  • Autoantibodies / cerebrospinal fluid*
  • Biomarkers / blood
  • Biomarkers / cerebrospinal fluid
  • Brain / diagnostic imaging
  • Demyelinating Autoimmune Diseases, CNS / diagnosis*
  • Demyelinating Autoimmune Diseases, CNS / diagnostic imaging
  • Demyelinating Autoimmune Diseases, CNS / drug therapy
  • Demyelinating Autoimmune Diseases, CNS / immunology
  • Diagnosis, Differential
  • Disease Progression
  • Humans
  • Male
  • Myelin-Oligodendrocyte Glycoprotein / immunology*
  • Receptors, N-Methyl-D-Aspartate / immunology*

Substances

  • Autoantibodies
  • Biomarkers
  • MOG protein, human
  • Myelin-Oligodendrocyte Glycoprotein
  • Receptors, N-Methyl-D-Aspartate