York Alizabeth, Sacknovitz Ariel, Tugal Oya, Gulko Edwin, McGoldrick Patricia, Wolf Steven, Overby Philip
New York Medical College, Valhalla, New York, USA
New York Medical College, Valhalla, New York, USA.
BMJ Case Rep. 2025 Jun 30;18(6):e264841. doi: 10.1136/bcr-2025-264841.
In the paediatric population, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) phenotypes continue to be identified. We present a case of seropositive MOGAD that began as what appeared to be aseptic meningitis with elevated intracranial pressure, followed by inflammatory myelopathy. The paediatric patient presented with a four-day history of persistent frontal headache, vomiting and episodic confusion without a fever. Lumbar puncture showed elevated cerebrospinal fluid opening pressure and lymphocytic pleocytosis. Her headaches worsened despite treatment for increased pressure with acetazolamide. Her symptoms of inflammatory myelopathy emerged four days after admission. MRI brain at presentation demonstrated bilateral narrowing of the transverse sinuses as seen with idiopathic intracranial hypertension (IIH). After development of urinary retention and lower extremity symptoms, MRI spine showed signal abnormalities within the grey and white matter of both the cervical and thoracic spinal cord consistent with an inflammatory myelopathy. Serum MOG antibodies were positive. Here, we present a case of MOGAD that began with an aseptic meningitis-like presentation, but without the more commonly described initial presentations of MOGAD to illustrate an emerging phenotype. Aseptic meningitis with imaging suggestive of IIH, as well as symptoms in a paediatric patient, should raise suspicions for MOGAD and prompt MOG antibody testing.
在儿科人群中，髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）的表型仍在不断被发现。我们报告一例血清学阳性的MOGAD病例，该病例起初表现为疑似无菌性脑膜炎伴颅内压升高，随后发展为炎性脊髓病。该儿科患者有持续4天的前额部头痛、呕吐和发作性意识模糊症状，无发热。腰椎穿刺显示脑脊液初压升高和淋巴细胞增多。尽管使用乙酰唑胺治疗颅内压升高，但她的头痛仍加重。入院4天后出现炎性脊髓病症状。入院时脑部MRI显示双侧横窦狭窄，与特发性颅内高压（IIH）表现一致。出现尿潴留和下肢症状后，脊柱MRI显示颈段和胸段脊髓灰质和白质内信号异常，符合炎性脊髓病表现。血清MOG抗体呈阳性。在此，我们报告一例以类似无菌性脑膜炎表现起病，但无MOGAD更常见初始表现的MOGAD病例，以说明一种新出现的表型。对于有提示IIH的影像学表现的无菌性脑膜炎以及儿科患者出现的症状，应怀疑MOGAD并及时进行MOG抗体检测。
