stage disease (l-lllA) is surgical resection followed by chemotherapy and possible prophylactic cranial radiation. In locally advanced disease (IIIB-C) chemoradiation is the preferred therapy. Meanwhile, chemotherapy is the first-line therapy for advanced
disease, which includes a platinum compound plus etoposide and anti-PD1-therapy. Reporting this case with follow-up on response to treatment is valuable to guide future research to assess the effectiveness of current recommendations.
ISCHEMIC STROKE, INFECTION, OR AUTOIMMUNE? A CASE REPORT HIGHLIGHTING THE CHALLENGES TO DIAGNOSE MOGAD “MYELIN OLIGODENDROCYTE GLYCOPROTEIN ANTIBODY-ASSOCIATED DISEASE Ahmad Anbar, Mohamed Hekmat Alharami, Kevin R Hargrave; Louisiana State University, Lafayette, LA.
Introduction: Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is a recently recognized demyelinating disorder characterized by antibodies against MOG in the central nervous system. MOGAD presents with a wide range of neurological symptoms, including optic neuritis, myelitis, and encephalitis, making it difficult to distinguish from other demyelinating diseases like Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder (NMOSD). In rare cases, MOGAD can present with stroke-like symptoms, leading to delays in diagnosis and challenges in management. Case: A 23-year-old male presented with headache, left-sided weakness, and altered mental status. Physical examination revealed 0/5 strength in both upper and lower left extremities. A CT scan of the head was negative, and the patient received alteplase for suspected ischemic stroke. Midway through treatment, he experienced gingival bleeding, prompting discontinuation of alteplase. The patient was admitted to the intensive care unit for close monitoring, where his condition fluctuated, with periods of decreased alertness and episodes of absence seizures. An MRI of the brain showed no abnormalities, and a lumbar puncture revealed an elevated opening pressure of 43 cm H₂O and a white count of 400 cells/µL with a lymphocyte
predominance. The patient improved with supportive care and was discharged, only to return days later with slurred speech and a worsening headache. An electroencephalogram showed a right temporal lobe electrographic seizure. His condition progressed to include right optic neuritis. A repeat lumbar puncture showed a persistent elevated opening pressure and significant pleocytosis. An autoimmune workup, revealed MOG-IgG antibodies, confirming a diagnosis of MOGAD, the patient was started on IVIG with significant improvement and return to baseline. Discussion: This case reflects the complexity and diagnostic challenges associated with MOGAD. The patient’s initial symptoms, absence seizures, and waxing and waning mental status added further diagnostic ambiguity. Although no specific risk factor has been definitively linked to MOGAD, a possible association with seizure history may merit an investigation. This highlights the need for heightened clinical awareness and consideration of MOGAD in similar cases, as well as the challenges faced due to the limited availability of MOG-IgG testing. The ability to routinely test for MOG- IgG could potentially aid in early diagnosis and intervention, ultimately improving outcomes for patients with this complex and often elusive disorder.
IVIG WITH STEROIDS SUCCESSFULLY HALT A RECURRENT HYPERHAEMOLYSIS SYNDROME IN A YOUNG PATIENT WITH SICKLE CELL CRISIS Ahmad Anbar, Thomas Jason Simon, Mohamed Hekmat Alharami, Archa Rajesh, De’Angellica Vaughn-Allen; Louisiana State University, Lafayette, LA.
Introduction: Hyperhaemolysis syndrome is a rare blood transfusion complication putting patients requiring repeat transfusions frequently at risk for
this life-threatening condition. The mechanism is not completely understood but an immune reaction with complement and macrophage 38
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