Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Initially Presenting as Septic Meningoencephalitis in a 16-Year-Old Male.

Background: We describe a case of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in a 16-year-old patient who initially presented with clinical features of septic meningoencephalitis. This case outlines the importance of considering a diagnosis of MOGAD in patients who fail to improve with appropriate antimicrobial therapy or show a positive clinical response to glucocorticoids (often used in treatment of meningococcal meningitis). We emphasise the importance of recognising that an infectious prodrome can precede MOGAD. Case description: A 16-year-old male was admitted with vomiting, fever, headache, photophobia and altered mental state. He was treated for meningoencephalitis with initial clinical improvement. Lumbar puncture findings were suggestive of viral meningoencephalitis. During admission the patient went through several periods of transient clinical and biochemical improvement, alternating with periods of symptomatic relapse. On day 17 of admission, he was transferred to a tertiary centre for suspected autoimmune disseminated meningoencephalitis (ADEM) and two days later, he suffered a catastrophic neurological decline with new dysarthria, dysphagia, aphasia, horizontal nystagmus and facial paralysis. He made a remarkable neurological recovery after commencing treatment with IV immunoglobulin, IV methylprednisolone and plasma exchange, with complete resolution of symptoms. Conclusion: MOGAD can run a variable course and present soon after a central nervous system infection, making the diagnosis more challenging. Nonetheless, patients can achieve a full neurological recovery with early recognition, diagnosis and treatment of this rare entity. LEARNING POINTS: Autoimmune encephalitis can be preceded by an infectious prodrome which makes the diagnosis more challenging.Autoimmune encephalitis can run a subacute and fluctuating course with transient periods of symptomatic improvement preceding a rapid neurological decline.Glucocorticoids often used in treatment of patients with meningococcal meningitis may lead to transient symptomatic improvement in patients with autoimmune encephalitis, masking the diagnosis.MRI findings of demyelination in autoimmune encephalitis may lag behind clinical symptoms by days to weeks.

An unusual presentation of invasive aspergillosis with submandibular swelling in a 49-year-old man with end-stage renal disease: A case report.

Invasive aspergillosis (IA) is a fatal disease and is related to immunocompromised patients like HIV, solid organ/allogeneic stem cell transplant patients, patients on immunosuppressive therapy or chemotherapy agents, burn patients and malnourished patients. Diagnosis is challenging due to the non-specific nature of symptoms. Usually, the patient presents with fever and respiratory symptoms such as cough and haemoptysis. We present a case of IA in a 49-year-old man with end-stage renal disease who presented with fever and developed a submandibular swelling. Further imaging studies supported the possibility of having underlying IA and accordingly he was promptly treated with systemic antifungal therapy with good response. As per our knowledge, IA presenting as submandibular swelling has not been reported in the literature. Our main aim is to highlight the significance of early diagnosis and management in such a rare presentation associated with a life-threatening condition like IA.

A case of concomitant pulmonary embolism and pulmonary tuberculosis in the era of COVID 19, a matter of cautious approach.

Tuberculosis (TB) is known to the world for many years. It is associated with various complications and rarely with pulmonary embolism. However, due to its commonalities of presenting features with COVID 19, it can easily be missed and may be life threatening.