J Neurocrit Care.  2023 Jun;16(1):43-45. 10.18700/jnc.230020.

Myelin oligodendrocyte glycoprotein antibody-associated disease manifesting as intractable fever managed by bromocriptine: a case report

• Lee JS
• Lee S
• Oh Si

• KMID: 2543392
• DOI: http://doi.org/10.18700/jnc.230020

Abstract

Background
Demyelinating events expressed as abnormal thermoregulatory responses are rare, but intractable fever in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is very rarely reported.
Case Report
A 56-year-old woman presented with quadriparesis with acroparesthesia. During the admission, fever developed and persisted for 2 days despite the administration of high-dose antipyretics. Brain magnetic resonance imaging (MRI) showed hyperintense lesions involving the upper brainstem. A diagnosis of MOGAD was made according to the clinical characteristics and presence of seropositive MOG antibody. After administration of oral bromocriptine (2.5 mg/day), fever was slowly controlled for a few days.
Conclusion
The present case explained that persistent fever in MOGAD could manifest as an uncommon manifestation. The lesion in the upper brainstem within the brain MRI could be thought of as a lesion anterior to the periaqueductal gray and the lesion at that site could be the cause of the patient's persistent fever with unknown origin.

Keyword

Myelin oligodendrocyte glycoprotein antibody-associated disease; Fever; Encephalomyelitis

Figure

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  Fig. 1. (A, B) Brain magnetic resonance imaging (MRI) and (C, D) spinal cord MRI. (A) Axial and (B) coronal T2 fluid-attenuated inversion recovery images demonstrated hyperintense lesions (arrows) at both sides of the medulla, dorsal pons, and midbrain. Fluid-attenuated inversion recovery images demonstrated hyperintense lesions (arrows) at both sides of the medulla, dorsal pons, and midbrain. (C) Sagittal and (D) axial T2-weighted images show long segmental signal intensity changes (arrowheads) in the spinal cord, from T1 to T11 levels without swelling or abnormal enhancement.

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