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MOG Antibody-Associated Disease — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMOG Antibody-Associated DiseaseSCE Neurology

A 25-year-old man presents with bilateral optic neuritis with disc oedema and a short-segment thoracic myelitis. MRI brain shows bilateral perioptic enhancement and fluffy deep white matter lesions. CSF shows raised protein and pleocytosis but no oligoclonal bands. Serum MOG antibodies are positive at high titre on cell-based assay. AQP4 antibodies are negative. What is the diagnosis?

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Correct answer: E — MOG antibody-associated disease

This presentation is consistent with MOGAD: bilateral optic neuritis with disc oedema (characteristic of MOGAD), short-segment myelitis (unlike the LETM of AQP4+ NMOSD), fluffy brain lesions, absent OCBs, and confirmed MOG antibodies on cell-based assay. The 2023 International MOGAD Panel criteria require a core demyelinating event plus MOG antibody positivity, with exclusion of MS and AQP4+ NMOSD. A: MS would have OCBs and different lesion pattern. B: NMOSD requires AQP4 antibodies (absent here). D: ADEM lacks MOG antibodies in most cases. E: Neurosarcoidosis presents with meningeal enhancement.

Reference: International MOGAD Panel Criteria (Banwell et al., Lancet Neurol 2023)