Myelin oligodendrocyte glycoprotein antibody-associated disease as a novel presentation of central nervous system autoimmunity in a pediatric patient with Wiskott-Aldrich syndrome

• Published in: Allergy, asthma, and clinical immunology Vol. 19; no. 1; p. 68
• Main Authors: Xie, Vivien X, File, Wilson, Wiedl, Christina, Ward, Brant R, Saldaña, Blachy Dávila, Keller, Michael D, Kornbluh, Alexandra B
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.08.2023; BioMed Central; BMC
• Subjects: Anemia; Antibodies; Autoimmunity; B cells; Blood platelets; Case Report; Central nervous system; Children; Demyelination; Diagnosis; Disease susceptibility; Emergency medical care; Genetic aspects; Glycoproteins; Guillain-Barre syndrome; Health aspects; Immune system; Immunodeficiency; Immunoglobulin G; Immunoglobulins; Infection; Infections; Iron deficiency anemia; Levetiracetam; Lymphocytes; Mutation; Myelin oligodendrocyte glycoprotein antibody associated disease; Myelin proteins; Nervous system; Optic neuritis; Patients; Pediatrics; Risk factors; Thrombocytopenia; Visual acuity; Wiskott-Aldrich syndrome; Wiskott-Aldrich syndrome; Demyelination; Optic neuritis; Myelin oligodendrocyte glycoprotein antibody associated disease
• ISSN: 1710-1484; 1710-1492; 1710-1492
• DOI: 10.1186/s13223-023-00827-x

Wiskott-Aldrich syndrome (WAS) is an X-linked primary immunodeficiency caused by mutations in the WAS gene that leads to increased susceptibility to infections, thrombocytopenia, eczema, malignancies, and autoimmunity. Central nervous system (CNS) autoimmune manifestations are uncommon. We describe the case of a five-year-old boy with refractory thrombocytopenia and iron deficiency anemia who developed relapsing bilateral optic neuritis. Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) via serum fluorescence-activated cell sorting assay was positive (titer 1:100), confirming a diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). At age six, molecular panel testing for genes associated with primary immunodeficiency identified a missense WAS gene variant. He was subsequently found to have decreased WAS protein expression, consistent with a diagnosis of WAS. This case expands the reported spectrum of CNS autoimmunity associated with WAS and may help to inform long-term therapeutic options.