Myelin Oligodendrocyte Glycoprotein Antibody Disease and Epstein Barr Infection: A Case Report

Case Diagnosis: A 19-year-old previously healthy female was diagnosed with myelin oligodendrocyte glycoprotein antibody disease and concurrent Epstein-Barr infection.

Case Description or Program Description: Patient presented to an acute care hospital with urinary retention in the setting of a recent upper respiratory infection. She was found to have a urinary tract infection and discharged with a foley catheter. She returned to the emergency room with lower extremity weakness, where an MRI of her brain and spine showed disseminated encephalomyelitis. An infectious workup was negative, except for a positive serum monospot, consistent with active Epstein Barr Virus (EBV) infection, and coxsackie IgG (IgM negative). Cerebrospinal fluid (CSF) showed mild leukocytosis with negative viral studies, and an autoimmune workup was positive for myelin oligodendrocyte glycoprotein antibody disease (MOGAD).

Setting: Acute inpatient rehabilitation

Assessment/Results: The patient completed 2 rounds of intravenous immunoglobulin (IVIG), 5 days of intravenous steroids, and 7 days of plasmapheresis. She was discharged to acute inpatient rehabilitation on high dose oral steroids. At rehab, she continued to have urinary retention requiring a foley catheter, neurogenic bowel requiring a bowel program, and weakness in both lower extremities. At discharge, she was modified independent with activities of daily living and ambulating with a walker. Outpatient, she was continued on maintenance IVIG and a steroid taper, and was transitioned to an intermittent catheterization program.

Discussion (relevance): This is a rare case of MOGAD with concurrent EBV infection and negative CSF studies. While EBV has been associated with autoimmune diseases, including multiple sclerosis, data has been limited and mixed as to whether EBV could play a role in the pathogenesis of other demyelinating disorders.

Conclusions: MOGAD is most often idiopathic. While no causative relationship can be claimed in this case, it provides a novel example of concurrent MOGAD and viral infection. Additional case studies and larger scale studies may help identify further correlations.