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Case Reports
. 2022 Apr 14:13:832084.
doi: 10.3389/fimmu.2022.832084. eCollection 2022.

Case Report: A Case With MOGAD and Anti-NMDAR Encephalitis Overlapping Syndrome Mimicing Radiological Characteristics of CLIPPERS

Jia Guo  1 , Yujie Bu  1 , Wei Liu  1
Affiliations
Case Reports

Case Report: A Case With MOGAD and Anti-NMDAR Encephalitis Overlapping Syndrome Mimicing Radiological Characteristics of CLIPPERS

Jia Guo et al. Front Immunol. .

Abstract

Herein, we reported a case of a young man diagnosed with MNOS (anti-myelin oligodendrocyte glycoprotein associated disease (MOGAD) and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis overlapping syndrome, i.e., MNOS), whose imaging findings in magnetic resonance imaging (MRI) mimicked chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). We reported a case of refractory anti-NMDAR encephalitis that recurred after standard first-line and second-line treatment. The patient presented with CLIPPERS on imaging at recent hospital admission, and his MOG antibodies were seropositive. After intravenous methylprednisolone (IVMP) treatment, the patient's symptoms were significantly alleviated. In this case, we demonstrated that MNOS could mimic the radiological characteristics of CLIPPERS. Future studies should focus on the diagnosis and treatment of antibody overlap syndrome.

Keywords: CLIPPERS mimics; MNOS; MOGAD; anti-NMDAR encephalitis; autoimmune.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A, B) Spinal cord MRI showed T2-hypertense lesions at C5-6 (A) with slight Gd enhancement (B). (C–F) Multiple lesions on MRI of the brain. T2-hypertense in right center semicovale, lateral paraventricular, pons, left temporal lobe, with an obvious contrast-enhancing lesions in the left temporal lobe. (G) Brain MRI revealed a new T2-hyperintense lesion located in left pons with no-contrast enhancement. (H, I) Gd-enhanced MRI showed punctate and curvilinear enhancing lesions involving the right semi-oval center areas, the anterior and posterior angles of lateral ventricle, pons and bilateral cerebellar hemisphere in the right hemispheres of hemispheres, the anterior and posterior angles of lateral ventricles, pons and left cerebellar hemispheres, without evidence of leptomeningeal enhancement.
Figure 2
Figure 2
The timeline of relevant results and interventions during the diagnosis and treatment of our patient.
See this image and copyright information in PMC

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