{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:26Z","timestamp":1756339526591,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,17]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>In the paediatric population, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) phenotypes continue to be identified. We present a case of seropositive MOGAD that began as what appeared to be aseptic meningitis with elevated intracranial pressure, followed by inflammatory myelopathy. The paediatric patient presented with a four-day history of persistent frontal headache, vomiting and episodic confusion without a fever. Lumbar puncture showed elevated cerebrospinal fluid opening pressure and lymphocytic pleocytosis. Her headaches worsened despite treatment for increased pressure with acetazolamide. Her symptoms of inflammatory myelopathy emerged four\u2009days after admission. MRI brain at presentation demonstrated bilateral narrowing of the transverse sinuses as seen with idiopathic intracranial hypertension (IIH). After development of urinary retention and lower extremity symptoms, MRI spine showed signal abnormalities within the grey and white matter of both the cervical and thoracic spinal cord consistent with an inflammatory myelopathy. Serum MOG antibodies were positive. Here, we present a case of MOGAD that began with an aseptic meningitis-like presentation, but without the more commonly described initial presentations of MOGAD to illustrate an emerging phenotype. Aseptic meningitis with imaging suggestive of IIH, as well as <jats:italic>persistent or evolving<\/jats:italic> symptoms in a paediatric patient, should raise suspicions for MOGAD and prompt MOG antibody testing.<\/jats:p>","DOI":"10.1136\/bcr-2025-264841","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T10:25:15Z","timestamp":1751279115000},"page":"e264841","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Myelin oligodendrocyte glycoprotein antibody-associated disease with aseptic meningitis-like presentation in a paediatric patient"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0406-2903","authenticated-orcid":false,"given":"Alizabeth","family":"York","sequence":"first","affiliation":[{"name":"New York Medical College, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariel","family":"Sacknovitz","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York, USA"},{"name":"Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oya","family":"Tugal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology-Oncology, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Gulko","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"McGoldrick","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York, USA"},{"name":"Neurology, Boston Children\u2019s Health Physicians, Valhalla, New York, USA"},{"name":"Department of Pediatric Neurology, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Wolf","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York, USA"},{"name":"Neurology, Boston Children\u2019s Health Physicians, Valhalla, New York, USA"},{"name":"Department of Pediatric Neurology, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Overby","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York, USA"},{"name":"Department of Pediatric Neurology, Westchester Medical Center, Valhalla, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025082709013922000_18.6.e264841.1","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1212\/CON.0000000000001127","article-title":"Myelin Oligodendrocyte Glycoprotein\u2013Associated Disorders","volume":"28","author":"Longbrake","year":"2022","journal-title":"Continuum (Mount Lawley)"},{"key":"2025082709013922000_18.6.e264841.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11737-8"},{"key":"2025082709013922000_18.6.e264841.3","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000200275","article-title":"MOG CNS Autoimmunity and MOGAD","volume":"11","author":"Moseley","year":"2024","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2025082709013922000_18.6.e264841.4","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8"},{"key":"2025082709013922000_18.6.e264841.5","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1002\/acn3.51759","article-title":"Attack phenotypes and disease course in pediatric MOGAD","volume":"10","author":"Santoro","year":"2023","journal-title":"Ann Clin Transl Neurol"},{"key":"2025082709013922000_18.6.e264841.6","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2022.885218","article-title":"Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management","volume":"13","author":"Sechi","year":"2022","journal-title":"Front Neurol"},{"key":"2025082709013922000_18.6.e264841.7","article-title":"Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Report","volume":"16","author":"Teru","year":"2024","journal-title":"Cureus"},{"key":"2025082709013922000_18.6.e264841.8","doi-asserted-by":"crossref","first-page":"578083","DOI":"10.1016\/j.jneuroim.2023.578083","article-title":"Paediatric MOG-antibody disease presenting with intracranial hypertension and unilateral vision loss without radiological evidence of optic neuritis","volume":"378","author":"Maran","year":"2023","journal-title":"J Neuroimmunol"},{"key":"2025082709013922000_18.6.e264841.9","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000200020","article-title":"Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Intracranial Hypertension","volume":"9","author":"Chaudhuri","year":"2022","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2025082709013922000_18.6.e264841.10","doi-asserted-by":"crossref","first-page":"100028","DOI":"10.1016\/j.nerep.2021.100028","article-title":"Atypical myelin oligodendrocyte glycoprotein antibody disease presenting with isolated elevated intracranial pressure","volume":"1","author":"Valdrighi","year":"2021","journal-title":"Neuroimmunology Reports"},{"key":"2025082709013922000_18.6.e264841.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.28871","article-title":"Comparison of Spinal Cord Magnetic Resonance Imaging Features Among Children With Acquired Demyelinating Syndromes","volume":"4","author":"Fadda","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025082709013922000_18.6.e264841.12","doi-asserted-by":"publisher","DOI":"10.1111\/cei.13641"},{"key":"2025082709013922000_18.6.e264841.13","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.pediatrneurol.2013.03.007","article-title":"Viral-induced intracranial hypertension mimicking pseudotumor cerebri","volume":"49","author":"Ravid","year":"2013","journal-title":"Pediatr Neurol"},{"key":"2025082709013922000_18.6.e264841.14","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.20.24061"},{"key":"2025082709013922000_18.6.e264841.15","first-page":"S13","article-title":"The role of isoagglutinins in intravenous immunoglobulin-related hemolysis","volume":"55 Suppl 2","author":"Bellac","year":"2015","journal-title":"Transfusion"},{"key":"2025082709013922000_18.6.e264841.16","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1111\/trf.17028","article-title":"Incidence and risk factors for intravenous immunoglobulin-related hemolysis: A systematic review of clinical trial and real-world populations","volume":"62","author":"Cuesta","year":"2022","journal-title":"Transfusion"},{"key":"2025082709013922000_18.6.e264841.17","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1111\/trf.15846","article-title":"Isoagglutinin reduction in intravenous immunoglobulin (IgPro10, Privigen) by specific immunoaffinity chromatography reduces its reporting rates of hemolytic reactions: an analysis of spontaneous adverse event reports","volume":"60","author":"Shebl","year":"2020","journal-title":"Transfusion"},{"key":"2025082709013922000_18.6.e264841.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2015.01.002"},{"key":"2025082709013922000_18.6.e264841.19","doi-asserted-by":"crossref","first-page":"2979","DOI":"10.1007\/s10072-021-05122-4","article-title":"Clinical characteristics of MOG antibody disease: two case reports","volume":"42","author":"Guan","year":"2021","journal-title":"Neurol Sci"},{"key":"2025082709013922000_18.6.e264841.20","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-308346"},{"key":"2025082709013922000_18.6.e264841.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12974-020-01824-2","article-title":"Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients","volume":"17","author":"Jarius","year":"2020","journal-title":"J Neuroinflammation"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-264841","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:01:48Z","timestamp":1756310508000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-264841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,30]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2025-264841"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-264841","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}