{
  "abstract": "Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated disorder of the central nervous system (CNS) characterized by frequent involvement of the optic nerves and spinal cord. Autoantibodies against aquaporin-4 channels on astrocytes (Anti-AQP4) are the hallmark of this disease. This is a distinct entity from myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) being defined by the presence of antibodies against the myelin oligodendrocyte protein (anti-MOG). We would like to present a very rare case of a 53-year-old-woman who has dual AQP4 and MOG antibodies in serum and clinical presentation of myelitis. She presented initially with bilateral lower limb sensory deficits and lower limb weakness which was treated with oral prednisolone. Her second flare up of the illness occurred a varicella zoster infection. The third and fourth episodes consisted of lower limb sensory deficits and back pain. The patient has not experienced optic neuritis. Her initial cerebrospinal fluid (CSF) analysis (performed after the second episode) demonstrated 170 white blood cells/μL with protein of 0.36 g/L and glucose of 5.1 g/L without presence of oligoclonal bands. An MRI spine demonstrated nonspecific high T2 signal in the right anterior hemi cord from T6 to T7. MRI of the brain demonstrated nodular enhancement within the posterior horn and atrium of right lateral ventricle. High titer Anti-AQP-4 antibodies (1:1000) and high titre anti-MOG antibodies were detected in serum. The patient had a course of monthly IVIG for almost 1 year and despite this relapsed requiring commencement of rituximab.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroscience, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Sarah Butler"
    },
    {
      "affiliations": [
        "Barwon Health, University Hospital Geelong, Geelong, VIC, Australia"
      ],
      "name": "Siew Kar Chen"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Alfred Health, Melbourne, VIC, Australia",
        "Neuroimmunology, Neuroinflammation and Neurooncology (N^3) Lab, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Mastura Monif"
    }
  ],
  "title": "3467 AQP4-MOG double-positive neuromyelitis optica spectrum disorder",
  "uid": "4bd87557-7bef-5906-b02a-6ecdbb23a552"
}