Dados do Trabalho

Título

Anti-mog disease a differential diagnosis to be considered

RESUMO

Case presentation:
Patient G.A.M.C.R, 13-year-old, black woman. In December 2018 suffered a sudden event of amaurosis in the right eye followed by mild spontaneous improvement. Visual acuity 20-800 in the right eye and 20-20 in the left eye. With papilla pallor at direct fundoscopy. Under the hypothesis of acute inflammatory optic neuritis, cerebrospinal fluid collection and magnetic resonance of the brain were performed. Received treatment with methylprednisolone 1g/day for 5 days. A extensive propaedeutics for etiology of optic neuritis revealed MRI without alterations with absence of monoclonal peaks or oligoclonal bands in cerebrospinal fluid. Magnetic resonance imaging without criteria for multiple sclerosis. Negative anti-AQP4. Under the chance of isolated optic neuritis or spectrum of optic neuromyelitis, after treatment with methylprednisolone the visual acuity was for 20-200 in the right eye, remaining 20-20 in the left eye. Another test for anti-mog and anti-AQP4 was tried at the moment.
However, on 06-01-22, the patient seeks an emergency complaining of sudden low visual acuity, pain on eye movement with 20-800 in the right eye again and 20-20 in the left eye. But complaining of loss of definition for colors in both eyes . Direct fundoscopy with bilateral pallor. Made new therapy with methylprednisolone 1g a day for 5 days. The patient brings the result of the new test test for anti-AQP4 with non-reagent value but brings the result of the positive anti-mog test.
After pulse therapy there is improvement for color vision and visual acuity returns to the previous level with visual acuity 20-20 in the left eye and 20-200 in the right eye. Star using azathioprine with gradual dose escalation reaching 150mg-day and is maintained prednisone 10mg -day .
Since then, the disease is kept under control.

Discussion
In this case, we discuss the importance of considering differential diagnostics beyond the spectrum of optic neuromyelitis in cases of severe optic neuritis. In this sense, anti-mog disease has proved very relevant, especially in cases where there is severe optic neuritis but with specific examination of negative anti-AQP4.

Final Comments
Severe optic neuritis can be highly disabling and elucidation aiming at the best treatment of the conditions involves knowing the diagnostic hypotheses, considering them and well testing them. Anti-mog disease should be remembered in this context.

Palavras Chave

anti-mog disease, severe optic neuritis.