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Table 2 Case vignettes of patients at risk of MOG-IgG seropositivity (examples)

From: MOG encephalomyelitis: international recommendations on diagnosis and antibody testing

Example 1: 35-year-old woman presenting with bilateral acute ON. Develops transient blindness; fundoscopy shows papilledema; lumbar puncture reveals lymphomonocytic pleocytosis with 10% neutrophils and negative OCBs; brain MRI shows perioptic Gd enhancement but is otherwise normal; flaring up of symptoms after tapering of oral steroids; later recurrent ON attacks, stabilization with rituximab.
Example 2: 40-year-old woman with two attacks of acute, OCB-negative myelitis. Spine MRI shows an isolated short spinal cord lesion at first attack and a longitudinally extensive spinal cord lesion at relapse; brain MRI abnormal but no Dawson’s finger-type lesion, no juxtacortical U fibre lesion, and no lesion adjacent to a lateral ventricle that is ovoid or associated with an inferior temporal lobe lesion [36, 37, 50]; flaring up of myelitis symptoms after discontinuation of intravenous steroid treatment, good response to PEX.
Example 3: Young man with a previous diagnosis of “OCB-negative RRMS”. Predominantly ON and myelitis attacks; conus lesion with severe erectile and sphincter disturbance after first myelitis; longitudinally extensive optic nerve lesion with involvement of the optic chiasm; increase in relapse rate under treatment with interferon-beta but stabilization with rituximab.
Example 4: 42-year-old woman presenting with incomplete, painful tetraparesis. Previous diagnosis of RRMS with positive OCB; spinal cord MRI reveals a contiguous lesion extending from C3 to T1; negative serology for AQP4-IgG.
Example 5: ADEM-like presentation with large white matter lesions and disturbance of consciousness, brainstem lesions, and involvement of the entire spinal cord in a 25-year-old woman; onset 3 weeks after vaccination.
Example 6: Simultaneous unilateral ON and LETM extending into the brainstem in a 39-year-old man. CSF pleocytosis (90 white cells/μl) with 5% neutrophils; no CSF-restricted OCB; negative AQP4-IgG serostatus.
Example 7: Young woman presenting with recurrent and steroid-dependent isolated ON, previously classified as CRION; normal brain MRI.
Example 8: Young man with acute encephalitis and seizures. MRI reveals large cortical/subcortical white matter lesions not involving the inferior temporal lobe; good response to steroids; negative for typical viral and autoimmune causes of encephalitis.
  1. Abbreviations: ADEM acute disseminated encephalomyelitis, AQP4 aquaporin-4, CRION chronic relapsing inflammatory optic neuropathy, CSF cerebrospinal fluid, EM encephalomyelitis, Gd gadolinium, IgG immunoglobulin G, LETM longitudinally extensive transverse myelitis, MOG myelin oligodendrocyte glycoprotein, MRI magnetic resonance tomography, MS multiple sclerosis, ON optic neuritis, RRMS relapsing-remitting MS