The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab
The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been repor...
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1183488/full |
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| author | Rui Zhang Rui Zhang Li Wang Li Wang Yongli Tao Yongli Tao Xiaofeng Zhang Xiaofeng Zhang Kai Liu Kai Liu Bo Song Bo Song Yuming Xu Yuming Xu |
| author_facet | Rui Zhang Rui Zhang Li Wang Li Wang Yongli Tao Yongli Tao Xiaofeng Zhang Xiaofeng Zhang Kai Liu Kai Liu Bo Song Bo Song Yuming Xu Yuming Xu |
| author_sort | Rui Zhang |
| collection | DOAJ |
| description | The phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been reported as a feature of MOGAD and represent a diagnostic challenge. Meanwhile, the coexistence of MOG IgG and other CNS autoimmune antibodies is infrequent. We report a patient presented with isolated epileptic onset, relapsed with MRI-negative brainstem symptoms and MRI-negative encephalitis. He was positive for MOG IgG throughout the disease course while concomitant NMDAR IgG was not detected positive until second relapse. He showed decreasing response to conventional first-line therapy. The last relapse was during a COVID-19 epidemic with limited inpatient resources. Fortunately, he was ultimately controlled on subcutaneous ofatumumab, a novel fully humanized anti-CD20 mAb. This is the first report about subcutaneous ofatumumab treatment in MOG and NMDAR IgG double positive encephalitis with 12-month follow-up, depicting its potential as a therapeutic option. |
| first_indexed | 2024-03-12T14:41:32Z |
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| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-12T14:41:32Z |
| publishDate | 2023-08-01 |
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| series | Frontiers in Immunology |
| spelling | doaj.art-ecbc700d64b8473f988967c34db0c44a2023-08-16T07:51:03ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-08-011410.3389/fimmu.2023.11834881183488The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumabRui Zhang0Rui Zhang1Li Wang2Li Wang3Yongli Tao4Yongli Tao5Xiaofeng Zhang6Xiaofeng Zhang7Kai Liu8Kai Liu9Bo Song10Bo Song11Yuming Xu12Yuming Xu13Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaHenan Key Laboratory of Cerebrovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, ChinaThe phenotypic spectrum of myelin oligodendrocyte glycoprotein (MOG)- IgG–associated disorders (MOGAD) has broadened in the past few years, and atypical phenotypes are increasingly recognized. Isolated seizures and MRI-negative brainstem and cerebellar symptoms or encephalitis have rarely been reported as a feature of MOGAD and represent a diagnostic challenge. Meanwhile, the coexistence of MOG IgG and other CNS autoimmune antibodies is infrequent. We report a patient presented with isolated epileptic onset, relapsed with MRI-negative brainstem symptoms and MRI-negative encephalitis. He was positive for MOG IgG throughout the disease course while concomitant NMDAR IgG was not detected positive until second relapse. He showed decreasing response to conventional first-line therapy. The last relapse was during a COVID-19 epidemic with limited inpatient resources. Fortunately, he was ultimately controlled on subcutaneous ofatumumab, a novel fully humanized anti-CD20 mAb. This is the first report about subcutaneous ofatumumab treatment in MOG and NMDAR IgG double positive encephalitis with 12-month follow-up, depicting its potential as a therapeutic option.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1183488/fullisolated seizuresN-methyl-D-aspartate receptormyelin oligodendrocyte glycoproteinautoimmune encephalitisoverlap syndromeofatumumab |
| spellingShingle | Rui Zhang Rui Zhang Li Wang Li Wang Yongli Tao Yongli Tao Xiaofeng Zhang Xiaofeng Zhang Kai Liu Kai Liu Bo Song Bo Song Yuming Xu Yuming Xu The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab Frontiers in Immunology isolated seizures N-methyl-D-aspartate receptor myelin oligodendrocyte glycoprotein autoimmune encephalitis overlap syndrome ofatumumab |
| title | The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab |
| title_full | The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab |
| title_fullStr | The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab |
| title_full_unstemmed | The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab |
| title_short | The case report of MOG and NMDAR IgG double positive encephalitis treated with subcutaneous ofatumumab |
| title_sort | case report of mog and nmdar igg double positive encephalitis treated with subcutaneous ofatumumab |
| topic | isolated seizures N-methyl-D-aspartate receptor myelin oligodendrocyte glycoprotein autoimmune encephalitis overlap syndrome ofatumumab |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1183488/full |
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