Anti-MOG antibody-positive ADEM following infectious mononucleosis due to a primary EBV infection: a case report

• Published in: BMC neurology Vol. 17; no. 1; p. 76
• Main Authors: Nakamura, Yoshitsugu, Nakajima, Hideto, Tani, Hiroki, Hosokawa, Takafumi, Ishida, Shimon, Kimura, Fumiharu, Kaneko, Kimihiko, Takahashi, Toshiyuki, Nakashima, Ichiro
• Format: Journal Article
• Language: English
• Published: England BioMed Central 19.04.2017; BMC
• Subjects: Acute disseminate encephalomyelitis; Adult; Antecedent infection; Antibodies; Antigens; Aquaporin 4; Aquaporin 4 - immunology; Aquaporins; Autoantibodies - immunology; Blood tests; Case Report; Case reports; Cerebrospinal fluid; Cervical Cord - pathology; Demyelinating diseases; Demyelination; Encephalomyelitis; Encephalomyelitis, Acute Disseminated - complications; Encephalomyelitis, Acute Disseminated - immunology; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - immunology; Glycoproteins; Herpes viruses; Humans; Immunoglobulins; Infections; Infectious mononucleosis; Infectious Mononucleosis - complications; Infectious Mononucleosis - immunology; Inflammatory diseases; Influenza; Internal Capsule - pathology; Laboratories; Leukocytosis - cerebrospinal fluid; Magnetic Resonance Imaging; Male; Mononucleosis; Multiple sclerosis; Myelin; Myelin oligodendrocyte glycoprotein; Myelin-Oligodendrocyte Glycoprotein - immunology; Nervous system; Neuritis; Neurology; Neuromyelitis; Oligodendrocyte-myelin glycoprotein; Optic neuritis; Paresthesia; Patients; Pediatrics; Pleocytosis; Polymerase chain reaction; Spinal cord; Spinal Cord - pathology; Transverse myelitis; Viral infections; Case report; Antecedent infection; Acute disseminate encephalomyelitis; Myelin oligodendrocyte glycoprotein; Epstein–Barr virus; Transverse myelitis
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-017-0858-6

Anti-Myelin oligodendrocyte glycoprotein (MOG) antibodies are detected in various demyelinating diseases, such as pediatric acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and aquaporin-4 antibody-seronegative neuromyelitis optica spectrum disorder. We present a patient who developed anti-MOG antibody-positive ADEM following infectious mononucleosis (IM) due to Epstein-Barr virus (EBV) infection. A 36-year-old healthy man developed paresthesia of bilateral lower extremities and urinary retention 8 days after the onset of IM due to primary EBV infection. The MRI revealed the lesions in the cervical spinal cord, the conus medullaris, and the internal capsule. An examination of the cerebrospinal fluid revealed pleocytosis. Cell-based immunoassays revealed positivity for anti-MOG antibody with a titer of 1:1024 and negativity for anti-aquaporin-4 antibody. His symptoms quickly improved after steroid pulse therapy followed by oral betamethasone. Anti-MOG antibody titer at the 6-month follow-up was negative. This case suggests that primary EBV infection would trigger anti-MOG antibody-positive ADEM. Adult ADEM patients can be positive for anti-MOG antibody, the titers of which correlate well with the neurological symptoms.