A case of MOGAD optic neuritis initially mis-classified as CLIPPERS

Background

MOG antibody disease presents along a spectrum that includes acute disseminated encephalomyelitis, transverse myelitis, and optic neuritis. CLIPPERS is a rare condition that may complicate an accurate MOGAD diagnosis. This is in part due to overlapping clinical and imaging features with MOGAD.

Case report

Here we report a case of a 63-year-old woman with relapsing optic neuritis due to MOGAD that was initially concerning for CLIPPERS. The patient was seropositive for MOG-ab and responded well to high dose corticosteroid therapy which was tapered over 9-months.

Conclusion

This case underscores the importance of recognizing the overlap in clinical presentation that may occur between MOGAD and CLIPPERS despite both conditions having distinct biological origins. CLIPPERS criteria and the exclusion of alternative causes can help distinguish between the two. A MOG-ab titer should be used to screen MOGAD as a CLIPPERS mimicker. Antibody testing, clinical imaging, steroid responsiveness, history of present illness, and the extent of existing disability may provide a complete diagnostic picture.