Atypical initial presentation of MOGAD in a patient with probable tuberculous meningoencephalitis: Case report

Abstract

Tuberculosis (TB) is an endemic disease in our country that effects on various organs and at the nervous system. The diagnosis requires confirmatory tests, however if the suspicion is high, empirical treatment can be initiated with subsequent follow-up of the patient.

TB has been associated with neuromyelitis optica, however it didn't associate with MOG antibody disease (MOGAD). MOGAD is a rare entity in the adult population; its main manifestation is bilateral optic neuritis or acute disseminated encephalitis. Which also requires confirmatory tests and immunosuppressive treatment.

We report the case of a patient diagnosed with TB meningoencephalitis, in the second month of empirical treatment with anti-TB drugs, who was admitted to our service due to persistence of epileptic seizures and greater deterioration in the level of alertness. She was tested for infectious, autoimmune, tumor and metabolic diseases, which came out within the normal range. Magnetic resonance imaging showed apparently sequelae diffuse bilateral leukodystrophy without contrast enhancement. The possibility of autoimmune encephalitis was evaluated. Therefore, it decided to start treatment with immunoglobulin for 6 cycles. During her evolution, clinical improvement was evident, without epileptic seizures, with better interaction with his environment and she began to walk with a walker. At the end of the anti-TB and immunoglobulin treatment, she presented an episode of dysarthria and facial asymmetry. The new image showed nodular lesions in the midbrain and cerebellum, some of which captured contrast. Therefore, the studies were expanded and an anti-MOG test was performed, which was positive. It was decided to start immunoglobulin cycles. With apparently good clinical evolution.

Conclusion

We present the case of an atypical initial presentation of MOGAD. This should be taken into account in cases where there is no adequate clinical improvement, since treatment with corticosteroids or immunoglobulins may be effective in these patients and prevent serious sequelae.