SHM Converge Scientific Abstract ePoster Gallery-High Pressure, Low Clarity: An Atypical Presentation of Mog Antibody-Associated Disease

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This case describes an 11-year-old boy with chronic migraines who was admitted with two weeks of worsening headache, vomiting, fever, fatigue, and altered mental status. He initially had leukocytosis and elevated CRP, and his first lumbar puncture showed markedly elevated opening pressure and neutrophilic CSF pleocytosis, leading to treatment for presumed viral meningitis with vancomycin and ceftriaxone. Head CT was normal, and early infectious testing was unrevealing.<br /><br />Over the hospital course, his neurologic symptoms progressed, including blurry vision, left upper extremity dysmetria, numbness and tingling in the legs, diffuse hyperreflexia, and other concerning signs. These changes prompted involvement of Neurology, Infectious Diseases, Ophthalmology, and Rheumatology, along with repeat imaging and repeat lumbar puncture. The second LP again showed elevated opening pressure and inflammatory CSF findings. MRI brain demonstrated new ill-defined T2 hyperintensities in the cerebellar regions and subtle leptomeningeal enhancement, raising concern for myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).<br /><br />He was treated with high-dose steroids and IVIG for presumed autoimmune encephalitis/MOGAD. Subsequent testing confirmed a high MOG antibody titer (1:1000). He improved clinically and was discharged on a steroid taper with close neurology follow-up.<br /><br />Key teaching points are that neutrophilic CSF pleocytosis and high opening pressure do not rule out autoimmune or neuroinflammatory disease, MOGAD can closely mimic infectious meningitis early in its course, and evolving neurologic deficits should trigger repeat imaging and specialist consultation. The case highlights the important role of hospitalists in recognizing red flags and coordinating timely multidisciplinary care and immunomodulatory treatment.

Asset Subtitle

Sanjana Mandilwar

Meta Tag

Author List Lynn McDaniel, Sanjana Mandilwar

Category Clinical Vignettes

Concept Autoimmune Encephalitis

Concept MOG Antibody-Associated Disease

Concept Cerebrospinal Fluid Pleocytosis

Concept Immunomodulatory Treatment

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization University of Virginia

Presenting Author Sanjana Mandilwar

Track Pediatric

Keywords

MOGAD

autoimmune encephalitis

neutrophilic CSF pleocytosis

elevated opening pressure

pediatric migraine

meningitis mimic

MRI cerebellar hyperintensities

leptomeningeal enhancement

IVIG treatment

high-dose steroids

Autoimmune Encephalitis

MOG Antibody-Associated Disease

Cerebrospinal Fluid Pleocytosis

Immunomodulatory Treatment

Altered Mental Status