{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:45Z","timestamp":1784527425782,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>We present a 69-year-old female patient who initially manifested with depression and anhedonia, initially misdiagnosed as primary psychiatric illness. She subsequently developed progressive gait instability and cognitive decline. After comprehensive clinical and laboratory evaluation, she was finally diagnosed with multiple sclerosis (MS) complicated by neuropsychiatric systemic lupus erythematosus (NPSLE). Brain magnetic resonance imaging (MRI) revealed multifocal white matter lesions consistent with demyelination. Serologic testing demonstrated positivity for antinuclear antibody (ANA), anti-double-stranded DNA (dsDNA), anti-SS-A\/Ro, anti-histone, anti-nucleosome, and anti-centromere antibodies. Cerebrospinal fluid (CSF) examination confirmed intrathecal synthesis of immunoglobulin G (IgG), as evidenced by CSF-restricted oligoclonal bands (OCBs). Serum myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) was positive at a titer of 1:32, whereas aquaporin-4 (AQP4) antibodies were negative. Based on the clinical manifestations, laboratory results and disease progression, the final diagnosis was established as coexisting MS and NPSLE. The patient achieved clinical improvement after treatment with glucocorticoids and hydroxychloroquine. This case highlights the diagnostic challenges posed by overlapping autoimmune central nervous system (CNS) disorders and underscores the importance of longitudinal assessment in differentiating MS from MOG-IgG-associated disorder (MOGAD) and NPSLE.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1879355","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:35:41Z","timestamp":1784525741000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Overlapping multiple sclerosis and neuropsychiatric systemic lupus erythematosus with positive MOG-IgG: a case initially misdiagnosed as depression"],"prefix":"10.3389","volume":"17","author":[{"given":"Wan","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Neurology, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuhai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumeng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqin","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou First People's Hospital (Hangzhou Geriatric Hospital)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/art.40930","article-title":"2019 European league against rheumatism\/American college of rheumatology classification criteria for systemic lupus erythematosus","volume":"71","author":"Aringer","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"B3","article-title":"Delayed diagnosis and treatment of systemic lupus erythematosus with a psychiatric presentation","volume-title":"Webm&M: Case Studies","author":"Bourgeois","year":"2019"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.31138\/mjr.32.2.164","article-title":"Autoimmune rheumatic diseases masquerading as psychiatric disorders: A case series","volume":"32","author":"Ravan","year":"2021","journal-title":"Mediterr J Rheumatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.71457","article-title":"Unveiling neuropsychiatric lupus: A case of SLE presenting with depressive symptoms and literature review","volume":"13","author":"He","year":"2025","journal-title":"Clin Case Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1080\/13854046.2024.2370963","article-title":"Neuropsychological profile of a patient with multiple sclerosis and psychiatric symptoms that masked and delayed the diagnosis. A case report using teleneuropsychology","volume":"39","author":"Reyes-M\u00e9ndez","year":"2025","journal-title":"Clin Neuropsychol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/molecules29040747","article-title":"Neuropsychiatric systemic lupus erythematosus: molecules involved in its imunopathogenesis, clinical features, and treatment","volume":"29","author":"Justiz-Vaillant","year":"2024","journal-title":"Molecules"},{"key":"B8","doi-asserted-by":"publisher","first-page":"997","DOI":"10.55563\/clinexprheumatol\/4uc7e8","article-title":"Systemic lupus erythematosus: one year in review 2023","volume":"41","author":"Zucchi","year":"2023","journal-title":"Clin Exp Rheumatol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.17969","article-title":"Neuropsychiatric systemic lupus erythematosus: A 2021 update on diagnosis, management, and current challenges","volume":"13","author":"Sarwar","year":"2021","journal-title":"Cureus"},{"key":"B10","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12916-015-0269-8","article-title":"Neuropsychiatric lupus: a mosaic of clinical presentations","volume":"13","author":"Kivity","year":"2015","journal-title":"BMC Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-018-0156-8","article-title":"Neuropsychiatric lupus: new mechanistic insights and future treatment directions","volume":"15","author":"Schwartz","year":"2019","journal-title":"Nat Rev Rheumatol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-024-01005-2","article-title":"The influence of MOGAD on diagnosis of multiple sclerosis using MRI","volume":"20","author":"Geraldes","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-025-08194-8","article-title":"MOG antibody-positive patients meeting diagnostic criteria for MS: is it MOGAD with an MS-like phenotype or true MS","volume":"46","author":"Seok","year":"2025","journal-title":"Neurol Sci"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200329","article-title":"Lupus myelitis\u201d Revisited: A retrospective single-center study of myelitis associated with rheumatologic disease","volume":"12","author":"Krett","year":"2025","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key282","article-title":"Association of antibodies against myelin and neuronal antigens with neuroinflammation in systemic lupus erythematosus","volume":"58","author":"Pr\u00f6bstel","year":"2019","journal-title":"Rheumatol (Oxford)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1186\/s13317-019-0117-5","article-title":"Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options","volume":"10","author":"Andravizou","year":"2019","journal-title":"Auto Immun Highlights"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurot.2025.e00601","article-title":"Progressive multiple sclerosis: Evaluating current therapies and exploring future treatment strategies","volume":"22","author":"Albelo-Mart\u00ednez","year":"2025","journal-title":"Neurotherapeutics"},{"key":"B18","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ncl.2017.08.003","article-title":"New insights into multiple sclerosis clinical course from the topographical model and functional reserve","volume":"36","author":"Krieger","year":"2018","journal-title":"Neurol Clin"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.5603\/pjnns.103538","article-title":"Clinical, immunological and neuroimaging spectrum of CNS lupus: can we reliably differentiate it from MS","volume":"58","author":"W\u00f3jcicka-Frankiewicz","year":"2024","journal-title":"Neurol Neurochir Pol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.889613","article-title":"Demyelinating syndromes in systemic lupus erythematosus: data from the \u201cAttikon\u201d Lupus cohort","volume":"13","author":"Nikolopoulos","year":"2022","journal-title":"Front Neurol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/S1474-4422(15)00393-2","article-title":"MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines","volume":"15","author":"Filippi","year":"2016","journal-title":"Lancet Neurol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(83)91075-6","article-title":"Intrathecal IgG synthesis and blood-brain barrier impairment in patients with systemic lupus erythematosus and central nervous system dysfunction","volume":"74","author":"Winfield","year":"1983","journal-title":"Am J Med"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1879355\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:35:42Z","timestamp":1784525742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1879355\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":22,"alternative-id":["10.3389\/fimmu.2026.1879355"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1879355","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"article-number":"1879355"}}