Min Chen, Zhuajin Bi, Peidong Liu, Ruoyu Li, Ju Liu, Hongbo Liu
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Front Immunol. 2025 Jan 7;15:1510097. doi: 10.3389/fimmu.2024.1510097. eCollection 2024.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) caused by pathogenic immunoglobulin G antibodies to myelin oligodendrocyte glycoprotein is a rare demyelinating disease of the central nerve system (CNS). The clinical phenotypes of MOGAD include acute disseminated encephalomyelitis, optic neuritis, and transverse myelitis. At present, the mechanism underlying the disease is unknown. Herein, we report two cases of MOGAD accompanied by Epstein-Barr virus (EBV) infection. Both presented inflammation response in the cerebrospinal fluid (CSF), demonstrating elevated level of cell accounts and protein. EBV genomic sequence was also detected in the CSF samples. The patients recovered substantially after 3 months following a combination treatment with methylprednisolone and immunosuppressive therapy with ofatumumab. These cases provide new insight into the production of MOG-IgG and the possible pathological mechanisms underlying MOGAD. The cases also confirm the association with EBV, a virus that infects human B cells and has been proposed to be a trigger for MOGAD. This is the first report on subcutaneous ofatumumab treatment for MOGAD triggered by EBV, suggesting that this is a potentially valuable therapeutic option.
由针对髓鞘少突胶质细胞糖蛋白的致病性免疫球蛋白G抗体引起的髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）是一种罕见的中枢神经系统（CNS）脱髓鞘疾病。MOGAD的临床表型包括急性播散性脑脊髓炎、视神经炎和横贯性脊髓炎。目前，该病的发病机制尚不清楚。在此，我们报告2例伴有爱泼斯坦-巴尔病毒（EBV）感染的MOGAD病例。二者脑脊液（CSF）均出现炎症反应，表现为细胞计数和蛋白质水平升高。在CSF样本中也检测到EBV基因组序列。在接受甲泼尼龙和奥法妥木单抗免疫抑制联合治疗3个月后，患者基本康复。这些病例为MOG-IgG的产生及MOGAD潜在的病理机制提供了新的见解。这些病例还证实了与EBV的关联，EBV是一种感染人类B细胞的病毒，有人提出它是MOGAD的触发因素。这是关于皮下注射奥法妥木单抗治疗由EBV引发的MOGAD的首例报告，表明这是一种具有潜在价值治疗选择。
