Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) after recent COVID19 infection and COVID19 vaccination - a case presentation
Apresentação do caso: Paciente do sexo feminino, 53 anos, previamente diabética, hipertensa e dislipidêmica, com quadro clínico de instalação gradual de perda visual em olho esquerdo (OE) de predomínio central, dor à mobilização ocular em OE e cefaleia. Ao exame físico, apresentava acuidade visual (AV) de contar dedos em OE, presença de defeito pupilar aferente relativo em OE, edema de papila em OE ao exame de fundo de olho e restante do exame neurológico sem alterações. Os sintomas iniciaram após 22 dias da primeira dose da vacina contra o COVID-19 (Astrazeneca) e 15 dias após infecção por COVID-19 (teste antígeno SARSCOV-2 reagente) com comprometimento pulmonar leve-moderado bilateral. Nega eventos neurológicos prévios. Foi internada no setor de Neurologia do Hospital das Clinicas Samuel Libânio em Pouso Alegre- Minas Gerais, com exames laboratoriais apresentando sorologias para COVID-19 IgM Reagente e IgG Reagente, PCR aumentado, demais exames gerais sem alterações (hemograma, funções tireoidiana, hepática e renal), demais sorologias infecciosas sem quadros agudos (HIV, Arboviroses, Herpes simplex vírus 1 e 2, Citomegalovírus, Toxoplasmose, VDRL, Hepatites B e C), provas reumatológicas negativas, liquor com resultado normal (incluindo sorologias e culturas infecciosas). Realizada ressonância magnética (RM) de órbitas evidenciando sinais de neurite óptica à esquerda com realce ao contraste paramagnético, sem extensão para quiasma óptico. Realizadas RM de encéfalo, colunas cervical e torácica sem alterações relevantes. Optado por pulsoterapia com Metilprednisolona um grama/dia durante cinco dias e paciente evoluiu com recuperação parcial da AV em OE (20/200). Devido neurite óptica atípica (perda acentuada da AV, baixa recuperação com corticoterapia, idade da paciente) foram solicitados exames séricos de anticorpo antiaquaporina 4 com resultado negativo e anticorpo anti-MOG com resultado positivo. Realizado potencial evocado visual evidenciando processo desmielinizante nas vias visuais pré-quiasmáticas do OE. Diante dos achados, realizado diagnóstico de Doença Associada ao Anticorpo Anti-MOG (MOGAD) e posteriormente prescrito Azatioprina associado a corticoterapia, sem novos eventos neurológicos e com melhora progressiva do quadro visual.
Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) after recent COVID19 infection and COVID19 vaccination - a case presentation
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DOI: 10.22533/at.ed.1593272315041
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Palavras-chave: COVID19. MOGAD. Vacinação.
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Keywords: COVID19. MOGAD. Vaccination.
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Abstract:
Presentation of the case: Female patient, 53 years old, previously diabetic, hypertensive, and dyslipidemic; with a clinical picture of gradual visual loss installation of central predominance in the left eye (LE), pain at ocular mobilization in the LE, and cephalea. On physical examination, she presented visual acuity (VA) of counting fingers in the LE, presence of a relative afferent pupillary defect in the LE, papilledema in the LE on dilated eye examination, and remaining neurological examination without alterations. Symptoms began 22 days after the first dose of the COVID-19 vaccine (AstraZeneca) and 15 days after COVID-19 infection (SARSCOV-2 antigen reagent test) with bilateral mild-moderate lung impairment. She denies previous neurological events. She was admitted to the Neurology Department of Samuel Libânio Clinical Hospital in Pouso Alegre - Minas Gerais, with laboratory tests presenting serologies for COVID-19 IgM Reagent and IgG Reagent, increased PCR, other general tests without alterations (blood count, thyroid, hepatic and renal functions), other infectious serologies without acute conditions (HIV, arboviruses, Herpes simplex virus 1 and 2, cytomegalovirus, toxoplasmosis, VDRL, Hepatitis B, and C), negative rheumatological tests, and liquor with a normal result (including serologies and infectious cultures). Magnetic resonance imaging (MRI) of the orbits shows signs of optic neuritis on the left, with paramagnetic contrast enhancement, without extension for optic chiasm. The MRI of the brain, cervical and thoracic spine was performed without any relevant changes. Opted for pulse therapy with methylprednisolone one gram/day for five days, and the patient evolved with partial recovery of VA in the LE (20/200). Due to atypical optic neuritis (acute loss of VA, poor recovery with corticosteroid therapy, age of the patient), serum tests of antiaquaporin 4 antibody with negative result and anti-MOG antibody with positive result were requested. Was performed a visual evoked potential evidencing demyelinating process in the pre-chiasmatic visual pathways of the LE. In view of the findings, a diagnosis of Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD) was made, and subsequently, azathioprine was prescribed associated with corticosteroid therapy, without new neurological events and with progressive improvement of the visual picture.
- HIAGO ANTUNIS SILVA
- MAYCON MELO LOPES
- PATRÍCIA MARQUES MENDES
- YAN DA SILVA RAPOSO
- ILANA WERNECK AUGSTEN
- HIARA GABRIELLE SILVA
