A case of bilateral limbic and recurrent unilateral cortical encephalitis with anti-myelin oligodendrocyte glycoprotein antibody positivity

Brain Dev. 2022 Mar;44(3):254-258. doi: 10.1016/j.braindev.2021.10.011. Epub 2021 Nov 18.

Abstract

Background: Anti-myelin oligodendrocyte glycoprotein (MOG) antibody can be detected not only in acute disseminated encephalomyelitis or optic neuritis but also in limbic or cortical encephalitis. However, no previous reports have demonstrated a relapsing case of these two types of encephalitis.

Case report: An 11-year-old girl presented with fever, headache, abnormal behavior, focal impaired awareness seizures (FIAS) on the left side, and MRI hyperintensities in the bilateral amygdala, hippocampus, and right posterior temporal cortex. The symptoms were alleviated with two courses of intravenous methylprednisolone (IVMP) and one course of immunoglobulin. At 16 years of age, the patient returned with left-sided headache and MRI hyperintensities in the left temporal, parietal, and insular cortices, which improved after 3 courses of IVMP. Oral prednisolone (PSL) was tapered over 6 months, when FIAS reappeared on the right side of the body. MRI showed recurrence in the same regions as in the second episode. She received 3 courses of IVMP, followed by gradually tapered PSL without relapse for 1.5 year. Anti-MOG antibodies were positive in both serum and the cerebrospinal fluid prior to treatment in all three episodes.

Conclusion: Our results revealed that anti-MOG antibody-related bilateral limbic and unilateral cortical encephalitis can manifest with a variety of phenotypes over time in the same patient.

Keywords: Autoimmune encephalitis; Cortical encephalitis; Limbic encephalitis; Myelin oligodendrocyte glycoprotein; Seizure.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / pathology*
  • Encephalitis* / drug therapy
  • Encephalitis* / immunology
  • Encephalitis* / pathology
  • Encephalitis* / physiopathology
  • Female
  • Humans
  • Immunologic Factors / administration & dosage
  • Limbic Encephalitis / drug therapy
  • Limbic Encephalitis / immunology
  • Limbic Encephalitis / pathology
  • Limbic Encephalitis / physiopathology
  • Myelin-Oligodendrocyte Glycoprotein / immunology*
  • Recurrence

Substances

  • Immunologic Factors
  • MOG protein, human
  • Myelin-Oligodendrocyte Glycoprotein