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Abstract Details

Isolated Meningitis Is a Unique Clinical Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease
Autoimmune Neurology
P9 - Poster Session 9 (8:00 AM-9:00 AM)
14-003
To describe individuals with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) manifesting with isolated meningitis/meningoencephalitis.
Cases of meningitis have rarely been described in MOGAD, and such patients may not fulfill the 2023 MOGAD diagnostic criteria.

We reviewed the medical records of 346 patients in our MOGAD cohort and identified those with isolated meningitis attacks. Inclusion criteria were: 1) Meningeal symptoms or signs; 2) Cerebrospinal fluid (CSF) pleocytosis; 3) Absence of an infectious etiology; 4) MOG-IgG positive; 5) Initial brain imaging lacking parenchymal involvement.
Twenty patients were included (representing 6% of our total MOGAD cohort), with a median titer of 1:100 (interquartile range[IQR], 100–1000). The median age was 18 years (IQR, 9.6–33.2) and 13 were male (65%). The meningitis attack occurred at onset in 12 (60%) and as a relapse in 8 (40%). Presenting features included headache (n=20, 100%), fever (n=14, 70%), nausea/vomiting (n=13, 65%), photophobia (n=12, 60%), encephalopathy/meningoencephalitis (n=7, 35%), nuchal rigidity (n=6, 30%), and seizure (n=4, 20%). Increased intracranial pressure was present in 9/10 analyzed (90%; median=34 mmH2O; IQR, 26–40). CSF analysis revealed an elevated white blood cell count (WBC) in 20 (100%; median WBC 50/µL; IQR, 39–137; 67% lymphocytic; 18% neutrophilic). Two had leptomeningeal enhancement (10%). Fourteen (70%) received antimicrobials for presumed infectious meningitis. Only 3 (14%) episodes were initially attributed to MOGAD. Within the attack, 14 (70%) evolved into a characteristic cerebral core demyelinating event with parenchymal brain lesions detected on repeat imaging (n=11, 55%) or developed concurrent myelitis (n=3, 15%) or optic neuritis (n=3, 15%) at a median of 15 days (IQR, 11-20) from symptom onset.
Isolated meningitis or meningoencephalitis is a unique clinical phenotype of MOGAD that is under-recognized and mimics infectious meningitis.  Future iterations of MOGAD diagnostic criteria could consider incorporating this clinical phenotype.   
Authors/Disclosures
Albert Aboseif, DO (Mayo Clinic Rochester)
PRESENTER 		Dr. Aboseif has received research support from the Eugene & Marcia Applebaum Fellowship Grant.
Nabeela Nathoo, MD, PhD Dr. Nathoo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
John Chen John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.
Laura Cacciaguerra, MD, PhD (Mayo Clinic) Dr. Cacciaguerra has nothing to disclose.
Nisa Vorasoot, MD Dr. Vorasoot has nothing to disclose.
Samantha Banks, MD Dr. Banks has nothing to disclose.
Jan-Mendelt Tillema, MD (Mayo Clinic) Dr. Tillema has nothing to disclose.
Deena Tajfirouz, MD Dr. Tajfirouz has nothing to disclose.
Smathorn Thakolwiboon, MD (Mayo Clinic Health System) Dr. Thakolwiboon has nothing to disclose.
Michel Toledano, MD (Mayo Clinic) Dr. Toledano has nothing to disclose.
Sean J. Pittock, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.