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Mei Z, Wang J, Wang J, Liu X, Deng B, Yang W, Zhang X, Chen X, Yu H. Case report: Overlapping syndrome of MOG-IgG associated optic neuritis and autoimmune encephalitis with co-existence of anti-NMDAR and anti-GABA BR antibodies. Front Immunol 2025; 15:1461024. [PMID: 39877347 PMCID: PMC11772160 DOI: 10.3389/fimmu.2024.1461024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 12/24/2024] [Indexed: 01/31/2025] Open
Abstract
We report a case of optic neuritis (ON) secondary to autoimmune encephalitis (AE) in a patient with concomitant antibodies to N-methyl-D-aspartate receptor (NMDAR), gamma-aminobutyric acid-B receptor (GABABR), and myelin oligodendrocyte glycoprotein (MOG). The patient exhibited a constellation of symptoms, including vision loss, seizures, mental and behavioral disorders, cognitive impairment, and speech abnormalities. At the two-year follow-up, the patient's symptoms had abated entirely. Overlap syndrome of triple autoimmune antibodies is rare and the coexistence of antibodies to NMDAR, GABABR and MOG has not been reported till now. This case report provides novel experience of diagnosis and treatment in autoimmune overlap syndromes.
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Affiliation(s)
- Zhujun Mei
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi (National Regional Center for Neurological Diseases), Nanchang, Jiangxi, China
- Jiangxi Provincial People’s Hospital, Clinical College of Nanchang Medical College, First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Jingguo Wang
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi (National Regional Center for Neurological Diseases), Nanchang, Jiangxi, China
| | - Xiaoni Liu
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Bo Deng
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Wenbo Yang
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Xiang Zhang
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
| | - Hai Yu
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, Shanghai, China
- Department of Neurology, National Center for Neurological Disorders, Shanghai, China
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Verma R, Bal KPA, Chakraborty R. Myelin oligodendrocyte glycoprotein associated disease presenting as rhombencephalitis with horizontal gaze palsy. J Neurosci Rural Pract 2025; 0:1-3. [DOI: 10.25259/jnrp_268_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025] Open
Abstract
Myelin oligodendrocyte glycoprotein associated disease (MOGAD) has a variety of manifestations spanning from optic neuritis to acute disseminated encephalomyelitis-like presentations. Rhombencephalitic presentation is an unusual entity in MOGAD. A 36-year-old male presented with sub-acute onset diplopia, and facial and bulbar palsy with alteration in sensorium following febrile illness. The workup revealed demyelinating lesions, subtle optic neuritis, and positive antimyelin oligodendrocyte glycoprotein antibodies. The patient showed significant improvement with pulse steroid therapy. This case illustrates the prudentiality of early diagnosis and treatment of MOGAD which can give positive outcomes.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George’s Medical University Lucknow, Uttar Pradesh, India,
| | - K. P. Arjun Bal
- Department of Neurology, King George’s Medical University Lucknow, Uttar Pradesh, India,
| | - Rajarshi Chakraborty
- Department of Neurology, King George’s Medical University Lucknow, Uttar Pradesh, India,
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Gowda VK, Kumar G, Kinhal UV, Mahadevan A. Myelin Oligodendrocyte Glycoprotein Antibody Disease - MOGAD. Indian J Pediatr 2025; 92:89. [PMID: 39503959 DOI: 10.1007/s12098-024-05326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 10/30/2024] [Indexed: 12/12/2024]
Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, 560029, Karnataka, India.
| | - Girish Kumar
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, Karnataka, India
| | - Uddhava V Kinhal
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, 560029, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India
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Gklinos P, Athanasopoulos F, Giatrakou V, Arkoudis NA, Pournara D, Giagkou E, Tountopoulou A, Vassilopoulou S, Mitsikostas DD. Unveiling GFAP Astrocytopathy: Insights from Case Studies and a Comprehensive Review of the Literature. Antibodies (Basel) 2024; 13:79. [PMID: 39449321 PMCID: PMC11503365 DOI: 10.3390/antib13040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy, which was first identified in 2016, is an immune-mediated inflammatory disorder of the nervous system characterized by antibodies targeting GFAP. The exact pathogenic mechanisms, as well as the role of anti-GFAP antibodies, remain unclear; however, it seems that neuroinflammation is mediated by specific CD8+ T-cells and that neoplasms or viral infections can act as the initial trigger. Although the clinical spectrum of the disease is broad and heterogenous, GFAP astrocytopathy most commonly presents as meningoencephalitis with or without myelitis. Other symptoms include headache, visual disturbances, extrapyramidal or brainstem syndromes, and psychiatric manifestations including psychosis. The disease has a characteristically favorable response to steroid treatment while relapses occur in approximately 20-30% of the patients. METHODS We present two cases of GFAP astrocytopathy admitted to our hospital: a 43-year-old male with persistent headache and a 59-year-old female with acute dysarthria and swallowing difficulties followed by cognitive and behavioral symptoms. RESULTS Additionally, we conduct a comprehensive review of the literature to elucidate the role of anti-GFAP antibodies in disease pathogenesis and examine imaging characteristics, clinical manifestations, and treatment options for this recently described neuroimmunological condition. CONCLUSIONS This review presents two unusual cases of GFAP-astrocytopathy and provides evidence for the pathogenesis, clinical presentation, imaging characteristics and treatment options of the disease.
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Affiliation(s)
- Panagiotis Gklinos
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Fotios Athanasopoulos
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Vagia Giatrakou
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Nikolaos-Achilleas Arkoudis
- Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, 11528 Athens, Greece
- The Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece
| | - Dorothea Pournara
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Eirini Giagkou
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Argyro Tountopoulou
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Sofia Vassilopoulou
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
| | - Dimos-Dimitrios Mitsikostas
- First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (D.-D.M.)
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