A Case of MOG-associated Encephalomyelitisin the Setting of Post-COVID-19 Infection

ABSTRACT

Objective: N/A Background: COVID-19 infection has been shown to be associated with a number of neurologic sequelae in the post-infection period. There have been rare cases of autoimmune neurologic disease associated with COVID-19 infection. Here we present a case of myelin oligodendrocyte glycoprotein (MOG)-associated encephalomyelitis two months after COVID-19 infection. Design/Methods: N/A Results: A 44-year old female presented to the hospital with progressive decline in mentation and fevers for 1 week. Three months prior, she tested positive for COVID-19 by nasopharyngeal PCR testing, had mild symptoms and recovered at home. On presentation, neurologic examination showed sensory level at T8, lower extremity hyperreflexia. and gait instability. MRI of the neuroaxis showed bilateral white matter lesions in the brain and longitudinal cord lesions at multiple cervical and thoracic spinal levels. CSF showed lymphocyte-predominant pleocytosis. Patient was diagnosed with encephalomyelitis and started on plasma exchange and high dose steroids on alternating days with improvement in her symptoms. Patient was positive for serum MOG antibody. She was discharged on a prolonged prednisone taper. Conclusions: This case highlights the importance of testing for MOG antibody disease in patients presenting with findings of brain and spinal cord lesions after COVID-19 infection. The course of MOG-associated antibody disease in post-COVID patients is unknown and warrants further investigation.