Myelin oligodendrocyte glycoprotein (MOG) associated optic neuritis in a patient with idiopathic intracranial hypertension (IIH) and compressive optic neuropathy Case Report

Abstract

Abstract Background: Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) has a wide phenotypic expression and should be considered in a differential diagnosis of patients with optic disc edema and increased intracranial pressure even after a diagnosis of IIH has been established.Case presentation: A 53-year-old woman with a history of IIH presented with headache and visual loss. She had a BMI of 35.44 kg/m2 and a past medical history significant for depression, hepatitis C, hyperlipidemia, and uterine cancer post-hysterectomy. She had undergone multiple lumbar shunt surgeries for IIH and a pituitary adenoma resection. Her visual acuity was no light perception OD and counting fingers OS. Cranial MRI showed symmetric thin peripheral optic nerve sheath enhancement of the intra-orbital optic nerves OU. Serum MOG antibody was positive, and she was treated with intravenous steroids followed by plasma exchange and rituximab, but her vision did not improve.Conclusions: This case highlights the importance of considering MOGAD and compressive optic neuropathy in patients with a history of IIH that had previously been stable for years, but who then present with new onset vision loss and optic disc edema. MOGAD and pituitary adenoma compressive neuropathy are relatively rare diseases, but early recognition and treatment may improve visual outcomes and prevent further irreversible neurologic damage.