Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and Human Immunodeficiency virus infection: dilemmas in diagnosis and management: a case series

Journal of Medical Case Reports

Case Report

Deanna Saylor¹  Franclo Henning²  Jonathan Carr²  Naeem Brey²  Christine Albertyn²  Marié Du Preez²  Sarel Theron²  Yohane Gadama³  Kenneth Ssebambulidde⁴ 

[1] Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi;Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda;

关键词: Myelin oligodendrocyte glycoprotein (MOG);    MOGAD;    Opportunistic infections;    Advanced HIV disease;    Aquaporin-4;    Autoimmune diseases;    Case report;   

DOI  :  10.1186/s13256-023-04191-7

 received in 2023-08-30, accepted in 2023-09-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described autoimmune inflammatory disorder of the central nervous system (CNS). There is limited data on the association between Human Immunodeficiency virus (HIV) infection and MOGAD. We report three patients with HIV infection and myelin oligodendrocyte glycoprotein (MOG) antibodies in the setting of other central nervous system infections.Case descriptionsThe first patient, a 44-year-old black African man, presented with acute disseminated encephalomyelitis (ADEM) with positive serum MOG antibodies. He made a significant recovery with corticosteroids but had a quick relapse and died from sepsis. The second patient, an 18-year-old black woman, presented with paraplegia and imaging revealed a longitudinally extensive transverse myelitis and had positive serum MOG antibodies. She remained paraplegic after methylprednisone and plasmapheresis treatments. Her rehabilitation was complicated by development of pulmonary embolism and tuberculosis. The third patient, a 43-year-old mixed-race woman, presented with bilateral painless visual loss. Her investigations were notable for positive MOG antibodies, positive Varicella Zoster Virus on cerebral spinal fluid (CSF) and hyperintense optic nerves on magnetic resonance imaging (MRI). Her vision did not improve with immunosuppression and eventually died from sepsis.ConclusionOur cases illustrate the diagnostic and management challenges of MOGAD in the setting of advanced HIV infection, where the risk of CNS opportunistic infections is high even without the use of immunosuppression. The atypical clinical progression and the dilemmas in the diagnosis and treatment of these cases highlight gaps in the current knowledge of MOGAD among people with HIV that need further exploration.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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