Diagnosis and treatment analysis of recurrent autoimmune encephalitis with anti-myelin oligodendrocyte glycoprotein antibody and anti-N-methyl-D-aspartate receptor double-positive(report of one case)
10.3969/j.issn.1004-1648.2025.02.005
- VernacularTitle:复发的髓鞘少突胶质细胞糖蛋白抗体和N-甲基-D-天冬氨酸受体抗体双阳性自身免疫性脑炎的诊疗分析(附1例报告)
- Author:
Rui ZHAO
1
;
Sai GAO
;
Lei WU
Author Information
1. 719000 榆林市第一医院神经内科
- Publication Type:Journal Article
- Keywords:
myelin oligodendrocyte glycoprotein;
Rituximab;
relapse;
recurrence
- From:
Journal of Clinical Neurology
2025;38(2):92-95
- CountryChina
- Language:Chinese
-
Abstract:
To explore the experience for diagnosis and treatment of recurrent autoimmune encephalitis with anti-myelin oligodendrocyte glycoprotein(MOG)antibody and anti-N-methyl-D-aspartate receptor(NMDAR)double-positive.Methods Clinical data of a autoimmune encephalitis patient with double-positive for MOG antibody and anti-NMDAR antibody was obtained through retrospective analysis.Results Male patient,18 years old.He presented with intermittent headaches,a single episode of loss of consciousness and a convulsion in October 2017.He experienced decreased vision in the right eye in April 2018.Brain MRI showed abnormal signals in the right temporal-occipital junction and optic nerve,with the MOG-IgG antibody positive in the serum.The symptoms improved after treatment with methylprednisolone without immunosuppressants.In October 2018,the patient had another seizure.The MOG-IgG antibodies,both in serum and CSF,were positive,and the NMDAR-IgG antibody was positive in the CSF.Brain MRI exhibited abnormal signals and peripheral enhancement in the bilateral parietal,occipital,temporal lobes,and the corpus callosum.A diagnosis of MOG antibody-associated disease(MOGAD)was confirmed.The Symptoms controlled after administration of methylprednisolone and symptomatic treatment.Follow-up MRI showed a reduction in lesion signal and disappearance of enhancement.Subsequently,Rituximab was administered sequentially in October 2018,April 2019,August 2020 and July 2021.MOG and AQP4 antibodies in serum were negative when tested in July 2021 and July 2022.Unfortunately,the patient again experienced weakness in the left limb and episodic confusion with limb convulsions in March 2023.The re-test of MOG antibodies in serum and CSF were positive again,and CSF NMDAR-IgG antibody was also positive.MRI showed abnormal signals in the right frontal-parietal cortex with gyral-like enhancement.MOGAD relapse was considered,and symptoms improved after treatment with methylprednisolone.The re-examination of brain MRI showed the disappearance of the lesions.The patient was discharged after sequential Rituximab treatment.The patient had not experienced any further recurrence until 20th June 2023.Conclusions A clinical phenotype of this case of autoimmune encephalitis with double-positive antibodies for MOG and NMDAR is thought to be MOGAD.The treatment procedure indicated that positive antibodies can turn negative after immunotherapy.However,relapse may occur after drug discontinuation.Thus,it is worth further investigating the timing of starting and stopping immunosuppressive therapy,the frequency of monitoring autoantibodies,and the guidance for restarting immunotherapy.
