Dados do Trabalho

Título

MOG antibody-associated disease (MOGAD) after vaccination with Ad26.COV2.S

RESUMO

A previously healthy 37-year-old woman presented to the hospital with a 7-day history of progressive worsening eye pain, headache, blurry vision of the left eye, urinary retention, numbness in both hands, weakness in both legs, bilateral Babinski sign and Lhermitte sign. She had received one dose of the Ad26.COV2.S vaccine against SARS-CoV-2 13 days before the onset of symptoms. Laboratory findings included a positive MOG-Ab, negative AQP4-Ab, an elevated CSF leukocyte cell counts and protein levels, and a positive antinuclear antibody. Other results were non-significant. A magnetic resonance imaging (MRI) of the brain and the spine revealed multiple hyperintense lesions on the cerebral cortex, basal ganglia, and from the C5-level to the conus medullaris in FLAIR and T2-weighted images, with no post-contrast enhancement. The patient received high-dose IV steroids, 5 sessions of plasma exchange therapy, and oral steroids. She had a complete remission of the visual symptoms after the treatment, and was discharged in need of a walking aid, with an EDSS of 6,5, and in use of monthly intravenous immunoglobulin therapy (IVIg).

Eleven months after the episode, the patient was in a good general state, with only a mild urinary retention. Her EDSS was 3,0. A new MRI showed an almost complete resolution of the previous lesions, and MOG-Ab dosage was negative. She had received IVIg for 6 months and now was initiating Rituximab.

Cases of Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) developed after COVID-19 vaccination have been described. Although molecular mimicry between SARS-CoV-2 spike proteins and MOG is unclear, analyses of the cross-reactions between host and microbial proteins show a potential correlation between CNS inflammation and demyelinating diseases. In the reported case, the patient developed MOGAD 13 days after receiving an adenovirus vector-based vaccine against SARS-CoV-2, which is considered sufficient time for the creation of autoantibodies. MOG-Ab-associated disease is related to better outcomes than AQP4-Ab-associated disease, although MOGAD has a higher relapse rate of optic neuritis. Patients who remain seropositive after treatment seem to present more relapses. Therefore, a prospective follow-up of MOG-Ab titres is important for the prognosis evaluation.

This case presents a patient with MOGAD post Ad26.COV2.S vaccination with an unusual presentation and excellent recovery.