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Título

MOG associated disease following herpes 7 infection: a case report

RESUMO

A 34-year-old woman, on the 4th postoperative day of video surgery due to ruptured ectopic pregnancy, was hospitalized with a CSF suggestive of viral meningitis with a positive HHV-7 PCR and acyclovir was started. Evolved with a somnolence, associated with ampicillin for 21 days and a brain MRI was performed with a finding of diffuse hyperintensity on T2/flair in the brainstem without contrast enhancement, associated with lesions in the hippocampus and in the internal and posterior capsule/right lentiform nucleus, coexisting with diffuse leptomeningeal enhancement, with a fine and regular pattern. She developed urinary retention. Three days after discharge, she was diagnosed with a optic neuritis. A new CSF analysis revealed just a lymphocytic pleocytosis 53 cells/mm3 and no OCBs. She was readmitted with a classic clinic of an optic neuritis on the right (20/40). All types of blood tests were requested, with no changes. Therefore, she was treated with IV 5 grams methylprednisolone, and a new MRI revealed findings of involvement of the right optic nerve, in addition to signal hyperintensity on the side of the pons on cranial MRI associated with the finding on spinal MRI with anomalous gadolinium enhancement at the level of the conus medullaris, suspicious findings of an autoimmune nature due to MOGAD. Foscarnet was started for 14 days and on the hospital discharge, she presented resolution of all symptoms. Positive result of serum anti-mog antibodies. Primary infection with HHV-7 can occur in adults which can lead to different manifestations such as encephalomyelitis, however studies show that cases of secondary optic neuritis are uncommon. Onset of demyelinating diseases, such as multiple sclerosis, due to EBV infection have already been scientifically proven and the occurrence of MOGAD spectrum diseases have also been described after reports of infectious mononucleosis by EBV and VZV infection. Case reports showing an association between MOGAD and HHV-7 infection are rare. However, due to molecular similarity between virus from the herpes family to EBV, it can be suggested that the herpes virus family may be triggering agents of autoimmunity. Therefore, in the rare clinical presentation of MOGAD spectrum disease possibly triggered by an infection caused by HHV-7, the description of this case is very important for this etiology to be considered in the differential diagnosis of an infectious condition that evolves with demyelination.

Palavras Chave

herpes human virus 7, myelin oligodendrocyte glycoprotein antibody associated diseases, optic neuritis