In April 2019, the patient presented with a blurring of vision in her left eye and eventually visited an ophthalmologist. After providing 30 mg/day of oral prednisolone (PSL) therapy, the patient's symptoms improved, and the PSL dose was gradually reduced (9 mg/day). Currently, the patient tested negative for peroxidase 3-ANCA. In 2017, she was diagnosed with MPA due to otitis media, interstitial pneumonia, and positivity to myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) at 17.7 U/ml (<3.5 U/ml). Herein, we present a case of retrobulbar ON of MOGAD complicated with MPA, which was successfully treated with glucocorticoid and immunosuppressants.Īn 86-year-old woman was referred to our department due to a history of rapid blurring of vision within two weeks. However, there has been no report of microscopic polyangiitis (MPA) complicated with MOGAD. MPO-ANCA is an autoantibody to the cytoplasm of neutrophils, and it is often positive in the serum of patients with MPA. Interestingly, patients with NMO rarely present with positivity to myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) has been reported. However, in some cases that have not met NMOSD criteria, ON is considered to be caused by anti-MOG antibody-associated disease (MOGAD) independent of NMO or MS. In some cases, optic neuritis (ON) with positivity to anti-MOG antibody and negativity to an anti-AQP4 antibody is a disease concept that also meets the NMOSD criteria if they have one of the major clinical signs. Patients were then diagnosed with NMOSD if they test positive for anti-aquaporin 4 (AQP4) antibodies or present with one of the major clinical signs (including optic neuritis, myelitis, and brain disorders). The concept of neuromyelitis optica spectrum disorder (NMOSD) was proposed based on the revised international diagnostic standard criteria in 2015. A subtype of multiple sclerosis (MS) with a clinical phenotype of optic neuromyelitis has been recognized to form a distinct entity. The myelin oligodendrocyte glycoprotein (MOG) is expressed on the myelin sheath's outer surface therefore, it is likely to be targeted by autoantibodies.
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