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The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab

The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been repor...

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Autores principales: Zhang, Rui, Wang, Li, Tao, Yongli, Zhang, Xiaofeng, Liu, Kai, Song, Bo, Xu, Yuming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463181/
https://www.ncbi.nlm.nih.gov/pubmed/37649484
http://dx.doi.org/10.3389/fimmu.2023.1183488
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author Zhang, Rui
Wang, Li
Tao, Yongli
Zhang, Xiaofeng
Liu, Kai
Song, Bo
Xu, Yuming
author_facet Zhang, Rui
Wang, Li
Tao, Yongli
Zhang, Xiaofeng
Liu, Kai
Song, Bo
Xu, Yuming
author_sort Zhang, Rui
collection PubMed
description The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been reported as a feature of MOGAD and represent a diagnostic challenge. Meanwhile, the coexistence of MOG IgG and other CNS autoimmune antibodies is infrequent. We report a patient presented with isolated epileptic onset, relapsed with MRI-negative brainstem symptoms and MRI-negative encephalitis. He was positive for MOG IgG throughout the disease course while concomitant NMDAR IgG was not detected positive until second relapse. He showed decreasing response to conventional first-line therapy. The last relapse was during a COVID-19 epidemic with limited inpatient resources. Fortunately, he was ultimately controlled on subcutaneous ofatumumab, a novel fully humanized anti-CD20 mAb. This is the first report about subcutaneous ofatumumab treatment in MOG and NMDAR IgG double positive encephalitis with 12-month follow-up, depicting its potential as a therapeutic option.
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spelling pubmed-104631812023-08-30 The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab Zhang, Rui Wang, Li Tao, Yongli Zhang, Xiaofeng Liu, Kai Song, Bo Xu, Yuming Front Immunol Immunology The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been reported as a feature of MOGAD and represent a diagnostic challenge. Meanwhile, the coexistence of MOG IgG and other CNS autoimmune antibodies is infrequent. We report a patient presented with isolated epileptic onset, relapsed with MRI-negative brainstem symptoms and MRI-negative encephalitis. He was positive for MOG IgG throughout the disease course while concomitant NMDAR IgG was not detected positive until second relapse. He showed decreasing response to conventional first-line therapy. The last relapse was during a COVID-19 epidemic with limited inpatient resources. Fortunately, he was ultimately controlled on subcutaneous ofatumumab, a novel fully humanized anti-CD20 mAb. This is the first report about subcutaneous ofatumumab treatment in MOG and NMDAR IgG double positive encephalitis with 12-month follow-up, depicting its potential as a therapeutic option. Frontiers Media S.A. 2023-08-15 /pmc/articles/PMC10463181/ /pubmed/37649484 http://dx.doi.org/10.3389/fimmu.2023.1183488 Text en Copyright © 2023 Zhang, Wang, Tao, Zhang, Liu, Song and Xu https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Zhang, Rui
Wang, Li
Tao, Yongli
Zhang, Xiaofeng
Liu, Kai
Song, Bo
Xu, Yuming
The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title_full The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title_fullStr The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title_full_unstemmed The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title_short The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
title_sort case report of mog and nmdar igg double positive encephalitis treated with subcutaneous ofatumumab
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463181/
https://www.ncbi.nlm.nih.gov/pubmed/37649484
http://dx.doi.org/10.3389/fimmu.2023.1183488
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