Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis Following SARS-CoV-2 Vaccination

Abstract

Background and Aims: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is characterised by serum or cerebrospinal fluid (CSF) anti-MOG antibodies. The most common phenotype of MOGAD includes optic neuritis. Five cases of acute MOG-ON possibly induced by COVID-19 have been described, and there are several reports after prodromal infections, such as herpes simplex and other viruses. Methods: We carried out a retrospective review of the medical records including demographic, clinical and imaging data from a case. Results: A 28-year-old female patient complained of right eye pain worsened by eye movements and blurred vision, starting 5 days after receiving the Moderna COVID-19 vaccine. The visual acuity in the right eye was 20/25 and in the left eye was 20/20. There was normal pupillary function. Fundus examination of the right eye showed 360° optic disc oedema, with flame-shaped haemorrhage. Blood analysis identified anti-MOG antibodies. Optical coherence tomography showed and increase in retinal nerve fibre layer (RNFL) thickness. The Farnsworth-Munsell 100 hue test showed yellow/blue changes and visual evoked potentials revealed prolonged latency and right retrochiasmal pathway delayed conduction. Magnetic resonance imaging (MRI) of the orbits revealed optic nerve asymmetry with thickening and enhancement along with right optic nerve sheath. She had a normal MRI of her brain and normal CSF analysis. MOG antibody positive acute unilateral optic neuritis possibly induced by the Moderna vaccination was diagnosed and oral prednisolone was started. Full clinical and imaging recovery was achieved. Conclusions: The association between immunisation and demyelinating manifestations of the central nervous system is well documented, but little is known regarding the complications of COVID-19 immunisation. Our case of optic neuritis following COVID-19 vaccination suggests that, along with infection, immunisation might trigger an anti-MOG autoimmune response. Recognising that will help us diagnose and promptly treat these patients.