Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 17, Number 5, May 2026, pages 221-225

Successful Treatment of Overlapping Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease and Glial Fibrillary Acidic Protein Astrocytopathy With Plasma Exchange

Figures

↓  Figure 1. Magnetic resonance imaging (MRI) on admission. (a) High-intensity lesion in the left thalamus on diffusion-weighted imaging (DWI). (b) Corresponding low-intensity lesion on the apparent diffusion coefficient (ADC) map. (c) Fluid-attenuated inversion recovery (FLAIR) images demonstrating multiple spotty hyperintense white matter lesions.
Figure 1.
↓  Figure 2. Serial diffusion-weighted imaging (DWI) showing the appearance of new lesions. (a–c) Follow-up magnetic resonance imaging (MRI) on day 7 (a), day 20 (b), and day 35 (c) shows small hyperintense lesions appearing sequentially in the left corona radiata and near the occipital left horn of the lateral ventricle. (d–f) Corresponding fluid-attenuated inversion recovery (FLAIR) images acquired at the same time points (a–d, b–e, and c–f pairs) demonstrate hyperintense white matter lesions.
Figure 2.
↓  Figure 3. Contrast-enhanced magnetic resonance imaging (MRI) on day 11. (a–c) Contrast-enhanced MRI shows serpiginous perivascular enhancement in the basal ganglia along with leptomeningeal enhancement.
Figure 3.

Table

↓  Table 1. Laboratory Findings
 
CategoryTarget antigenResult
Antibodies other than anti-MOG, including those associated with paraneoplastic syndromes, were all negative at this time. AMPH: amphiphysin; ANA: antinuclear antibody; AQP4: aquaporin-4; APS: antiphospholipid syndrome; CASPR2: contactin-associated protein-like 2; CL-β2GP1: cardiolipin–β2 glycoprotein I; CV2 (CRMP5): collapsin response mediator protein 5; dsDNA: double-stranded DNA; GAD65: glutamic acid decarboxylase 65; HIV: human immunodeficiency virus; IgLON5: immunoglobulin-like cell adhesion molecule LON5; LGI1: leucine-rich glioma-inactivated 1; MOG: myelin oligodendrocyte glycoprotein; NMDA: N-methyl-D-aspartate; PNMA2 (Ma2): paraneoplastic Ma antigen 2; Recoverin: recoverin protein; Ri (ANNA-2): Ri antigen; SOX1: SRY-box transcription factor 1; SSA: Sjogren’s syndrome–related antigen A; SSB: Sjogren’s syndrome–related antigen B; Titin: titin protein; TPO: thyroid peroxidase; Tr(DNER): delta/notch-like epidermal growth factor–related receptor; Yo (PCA-1): Yo antigen; Zic4: zinc finger protein of the cerebellum 4.
Autoimmune/demyelinating antibodiesMOGPositive
AQP4; NMDA; LGI1; CASPR2; APS; IgLON5Negative
Paraneoplastic antibodiesHu; Yo; Ri; CV2; PNMA2; AMPH; SOX1; Recoverin; Titin; Zic4; GAD65; Tr(DNER)Negative
Systemic autoimmune antibodiesANA; SSA; SSB; dsDNA; cardiolipin; CL-β2GP1; thyroglobulin; TPONegative
Infectious screeningHIV antigen/antibodyNegative