Aseptic Meningitis and Papillary Edema: Uncommon Presentation of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)

Sep 29, 2026

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Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune disorder marked by central nervous system demyelination. The case describes prolonged aseptic meningitis in which anti-MOG antibodies were detected after symptom onset. The report also reviews prior MOGAD cases with an initial meningitis presentation. MOGAD presenting with meningitis without neurological symptoms or parenchymal brain lesions was rare and showed high cerebrospinal fluid opening pressures.

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CategoryHealthcare

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Abstract

Introduction

Case Presentation

Diagnosis and Initial Management

Immunotherapy and Clinical Course

Follow-up

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Review began 07/30/2025 Review ended 11/26/2025 Published 12/05/2025 © Copyright 2025 Kojima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98547 Open Access Case Report Aseptic Meningitis and Papillary Edema: Uncommon Presentation of Myelin Oligodendrocyte Glycoprotein AntibodyAssociated Disease (MOGAD) Naoko Kojima 1, Naoki Yamada 1, Ichiro Kuki 1, Hiroshi Sakuma 2, Shin Okazaki 1 1. Department of Pediatric Neurology and Neurolinguistics, Osaka City General Hospital, Osaka, JPN 2. Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, JPN Corresponding author: Naoko Kojima, [k.naoko519@gmail.com](k.naoko519@gmail.com) Abstract Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune disease characterized by central nervous system demyelination. We report a case of prolonged aseptic meningitis in which anti-MOG antibodies were subsequently detected. In addition, we review previously reported cases of MOGAD that initially presented with symptoms of meningitis. MOGAD with meningitis without neurological symptoms or parenchymal brain lesions was rare and characterized by high cerebrospinal fluid (CSF) opening pressures. Categories: Neurology, Pediatrics Keywords: aseptic meningitis, autoimmune encephalitis, cerebrospinal fluid, fever, headache, methylprednisolone, mogad, mog associated antibody disease (mogad), papillary edema, pleocytosis Introduction Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune disease characterized by central nervous system demyelination. It presents a diverse clinical picture, including optic neuritis (ON), transverse myelitis, acute disseminated encephalomyelitis (ADEM), and cerebral cortical encephalitis. In pediatric cases, the most frequently observed phenotype is ADEM, characterized byencephalopathic manifestations including fever, seizures, headache, disturbances of consciousness, and behavioral abnormalities. MRI typically demonstrates multiple lesions involving both the white and gray matter. An infectious prodrome may precede the onset of ADEM manifestations [1] . On the other hand, aseptic meningitis has been increasingly reported as the initial presentation of MOGAD in children. In recent years, however, many aspects remain ambiguous [2] . We report a case of prolonged aseptic meningitis in which anti-MOG antibodies were subsequently detected. In addition, we review previously reported cases of MOGAD that initially presented with symptoms of meningitis. Case Presentation A previously healthy five-year-old boy with persistent vomiting and fever, experiencing headaches for 14 days prior to admission, presented to our hospital. Neurological examination revealed marked nuchal stiffness and no other abnormalities. Peripheral blood tests revealed leukocytosis (21 .54 × 10³/μL) and a mild elevation of C-reactive protein (CRP), and a magnetic resonance imaging (MRI) of the head showed empty sella (Figure 1) . No contrast agent was used in the MRI examination. Ophthalmological examination revealed bilateral papillary edema of the fundus (Figure 2), and a cerebrospinal fluid (CSF) analysis revealed leukocytosis (123/µL) and an elevated opening pressure of 32 cmH₂O. (Table 1 shows the laboratory results with corresponding reference ranges.) Bacterial culture of cerebrospinal fluid and multiplex PCR testing were performed. Multiplex polymerase chain reaction (PCR) is a test for 14 types of bacteria, viruses, and fungi that are major pathogens causing meningitis and encephalitis. The results of both the multiplex PCRand bacterial culture were all negative. Glycerol and acetazolamide were initiated, and ceftriaxone was administered as

FAQs

What is the reported primary clinical presentation in this case?

The patient presented with prolonged aseptic meningitis characterized by persistent vomiting, fever, and severe headache with marked nuchal stiffness, followed by papillary edema.

How were infectious causes evaluated and ruled out?

Bacterial culture and multiplex PCR testing for common pathogens in cerebrospinal fluid were performed and returned negative, after which ceftriaxone was discontinued.

What treatment was used once an autoimmune mechanism was suspected?

Intravenous methylprednisolone (IVMP) was started for autoimmune-mediated meningitis; symptoms improved the next day and papillary edema resolved after three courses.

What serologic and CSF findings supported MOGAD?

Anti-MOG antibodies were positive in serum and spinal fluid at admission, oligoclonal bands were detected in CSF, and both CSF opening pressure and cell count improved with treatment.

Sep 29, 2026

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