Cerebral cortical encephalitis followed by recurrent CNS demyelination in a patient with concomitant anti-MOG and anti-NMDA receptor antibodies

Lei Zhou; Jingzi ZhangBao; Haiqing Li; Xiaoyang Li; Yongheng Huang; Min Wang; Chongbo Zhao; Jiahong Lu; Chuanzhen Lu; Yuxin Li; Chao Quan

doi:10.1016/j.msard.2017.09.023

Cerebral cortical encephalitis followed by recurrent CNS demyelination in a patient with concomitant anti-MOG and anti-NMDA receptor antibodies

Mult Scler Relat Disord. 2017 Nov:18:90-92. doi: 10.1016/j.msard.2017.09.023. Epub 2017 Sep 22.

Authors

Lei Zhou¹, Jingzi ZhangBao¹, Haiqing Li², Xiaoyang Li¹, Yongheng Huang³, Min Wang³, Chongbo Zhao⁴, Jiahong Lu¹, Chuanzhen Lu¹, Yuxin Li⁵, Chao Quan⁶

Affiliations

¹ Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China.
² Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China.
³ Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, China.
⁴ Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China; Department of Neurology, Jing'an District Centre Hospital of Shanghai, China.
⁵ Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China. Electronic address: liyuxin@fudan.edu.cn.
⁶ Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China. Electronic address: chao_quan@fudan.edu.cn.

PMID: 29141829
DOI: 10.1016/j.msard.2017.09.023

Abstract

We report the case of a patient who initially presented with fever, headache and seizure. MRI revealed a fluid attenuation inversion recovery (FLAIR) high-intensity lesion involving the right temporal, parietal and occipital cortex. Afterwards, the patient developed three recurrent episodes, manifested as brainstem encephalitis, optic neuritis and ADEM-like illness successively, indicating demyelination. Both of his serum anti-MOG and CSF anti-NMDAR antibodies were proved positive by transfected cell based assays. We consider our case to have cortical encephalitis due to certain autoimmune mechanism initially, and then developed MOG-antibody mediated recurrent demyelination in the following episodes.

Keywords: Autoimmune encephalitis (AIE); Myelin oligodendrocyte glycoprotein (MOG); N-methyl-D-aspartate receptor (NMDAR).

Publication types

Case Reports

MeSH terms

Adult
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnostic imaging
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / immunology
Autoantibodies / blood*
Autoantibodies / cerebrospinal fluid*
Biomarkers / blood
Biomarkers / cerebrospinal fluid
Brain / diagnostic imaging
Demyelinating Autoimmune Diseases, CNS / diagnosis*
Demyelinating Autoimmune Diseases, CNS / diagnostic imaging
Demyelinating Autoimmune Diseases, CNS / drug therapy
Demyelinating Autoimmune Diseases, CNS / immunology
Diagnosis, Differential
Disease Progression
Humans
Male
Myelin-Oligodendrocyte Glycoprotein / immunology*
Receptors, N-Methyl-D-Aspartate / immunology*

Substances

Autoantibodies
Biomarkers
MOG protein, human
Myelin-Oligodendrocyte Glycoprotein
Receptors, N-Methyl-D-Aspartate