SHM Converge Scientific Abstract ePoster Gallery-Sudden Darkness: Myelin Oligodendrocyte Glycoprotein Optic Neuritis Causing Bilateral Blindness

Pdf Summary

This case report describes a 42-year-old woman who developed sudden, painless bilateral vision loss after two weeks of bifrontal headaches and progressive right-eye blurring. On presentation, she had severe visual impairment, bilateral papilledema, afferent pupillary defects, and absent color vision in the right eye. MRI of the brain and orbits showed bilateral optic nerve edema and T2 hyperintense enhancement, consistent with optic neuritis.<br /><br />Because sudden bilateral blindness has a broad differential, she underwent extensive infectious and autoimmune testing, including syphilis, herpes viruses, cryptococcal antigen, CSF oligoclonal bands, ANA, SPEP/UPEP, and neuromyelitis optica/AQP4 testing. These studies were negative except for a positive myelin oligodendrocyte glycoprotein (MOG) IgG titer of 1:100, confirming MOG antibody-associated disease (MOGAD) with optic neuritis.<br /><br />She was treated acutely with high-dose intravenous methylprednisolone for three days followed by five sessions of plasma exchange. After treatment and steroid taper, her vision improved substantially to 20/40 in the right eye and 20/50 in the left, though optic disc pallor persisted. She was started on mycophenolate mofetil for maintenance immunosuppression. However, four months later she relapsed, with a persistent MOG titer of 1:100 and worsening vision, particularly in the left eye.<br /><br />The authors emphasize that MOGAD should be considered in patients with acute vision loss, especially bilateral optic neuritis. Diagnosis requires a compatible clinical syndrome, demyelinating CNS injury on imaging or neurophysiology, and positive anti-MOG IgG testing. Early recognition is important because prompt immunotherapy and plasma exchange can improve outcomes, but relapse remains a significant risk.

Asset Subtitle

Matthew Zimmerman

Meta Tag

Author List Jonathan Huang, Matthew Zimmerman, Yoo Mee Shin

Category Clinical Vignettes

Concept MOG Antibody-Associated Disease

Concept Optic Neuritis

Concept Bilateral vision loss

Concept Anti-MOG IgG

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Emory University J. Willis Hurst Internal Medicine Residency Program

Presenting Author Matthew Zimmerman

Track Adult

Keywords

MOG antibody-associated disease

optic neuritis

bilateral vision loss

papilledema

myelin oligodendrocyte glycoprotein IgG

intravenous methylprednisolone

plasma exchange

mycophenolate mofetil

relapse

demyelinating disease

MOG Antibody-Associated Disease

Optic Neuritis

Bilateral vision loss

Anti-MOG IgG

High-Dose Corticosteroid