Anti-myelin oligodendrocyte glycoprotein antibody-positive coursing with optic neuritis: Imaging and clinical implications

A 9-year-old boy was admitted to our institution with acute onset of bilateral blurry vision. Physical examination revealed bilateral papilledema. Cerebrospinal fluid analysis and comprehensive metabolic panel were normal. Magnetic resonance imaging (MRI) of the brain showed extensive bilateral optic nerve inflammation with post-contrast gadolinium enhancement on T1-weighted sequence. The involvement was limited to the anterior segments of the optic nerves sparing chiasma and optic tracts. Anti-aquaporin-4 antibody (AQP4) was negative while anti-myelin oligodendrocyte glycoprotein antibody (MOG) was positive. After intravenous methylprednisolone, his vision dramatically improved. The patient was discharged with only mildly impaired visual acuity, 2 weeks after admission. Follow-up brain MRI and MOG assay after 3 months were within normal limits