AUG 04, 2020
This case report details a patient who was diagnosed with myelin oligodendrocyte glycoprotein (MOG) antibody-associated optic neuritis and myelitis and COVID-19.
The patient was a 26-year-old Hispanic man who presented with bilateral atypical optic neuritis and subsequently diagnosed with MOG-associated disease. He was worked up for other causes of bilateral atypical optic neuritis, and in addition was sent for a SARS-CoV-2 PCR testing as the patient had an associated progressive dry cough. The SARS-CoV-2 test came back positive.
This case highlights the importance of thinking beyond the obvious. Although this patient was found to have a picture in keeping with MOG-associated disease and an extra step of caution was taken due to the symptom of dry cough, this led to the associated diagnosis of SARS-CoV-2 on top of the MOG-associated disease.
The pathophysiology of MOG-associated disease can be enticed by a preceding infectious process, and this particular case demonstrates the high likelihood. Once again, this highlights the importance of adding SARS-CoV-2 on the differential diagnosis of neuro-ophthalmic manifestations presenting to the emergency eye clinic during this time, particularly in cases that are known to be provoked by a preceding infectious process.
Although it has been more than 6 months since the pandemic started, we are learning more about the disease as the situation evolves. The SARS-CoV-2 infection has circulated around the world, and has manifested in different shapes and forms. We are learning that neuro-ophthalmic manifestations can be part of the SARS-CoV-2 infection or can be precipitated by the infection. Because we are still living in the midst of the pandemic, we should have heightened suspicion for COVID-19 with any neuro-ophthalmic presentation, and in particular relating to this case, in any neuro-ophthalmic manifestation with an established connection with a preceding viral infection.