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Progressive brain atrophy and white matter changes in MOG encephalomyelitis

A 43-year-old man with a history of 7 repeated optic neuritis episodes since the 1990s developed dysarthria, dysphagia, and gait disturbance in 2015 with T2 high signal intensity (HSI) lesion in the left frontal white matter. He tested positive for myelin oligodendrocyte glycoprotein (MOG) antibody using cell-based assay, at a titer of >1:1,280.1 During follow-up, longitudinal neurologic examinations revealed progressive neurologic deterioration without any acute aggravation of cognitive, cerebellar, motor, or sensory symptoms, despite treatment with corticosteroid, mycophenolate mofetil, and monthly IV immunoglobulin.2 His brain MRI revealed progressive brain atrophy combined with increased T2 HSI (figure) without any lesions in the spinal cord MRI. Progressive disease course with brain atrophy can be a manifestation of MOG encephalomyelitis.