Myelin oligodendrocyte glycoprotein antibody-associated disease presenting as abnormal swallowing: a case report

Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a newly classified demyelinating disease caused by the production of autoantibodies against myelin oligodendrocyte glycoprotein (MOG). The initial clinical symptoms of MOGAD are varied, and MOGAD only presenting with abnormal swallowing function is rarely reported. The wide range of clinical phenotypes and diverse imaging features make the diagnosis of MOGAD difficult. Case presentation Herein, we report a case of MOGAD presented with 6 years of non-progressive mild difficulty swallowing, with episodes of choking and nausea. The patient was originally suspected of having neoplastic lesions and possibly lymphoma based on symptoms and radiologic manifestations. However, the neuropathological findings of brain biopsy showed demyelination without tumor cells. Further serum and cerebrospinal fluid testing was performed using a cell-based assay, which showed positive results for MOG antibodies. Neurological symptoms improved following steroid treatment. No recurrence of symptoms occurred but the lesions remained during the 2-year follow-up. Conclusions This report helps to extend the symptom spectrum of MOGAD and raise awareness of the importance of differentiating between neoplastic and demyelinating lesions. Imaging suggests neoplastic lesions should be differentiated from demyelinating diseases.