Effective Short-Interval Intravenous Immunoglobulin Reinfusion in Steroid-Unresponsive Pediatric Myelin Oligodendrocyte Glycoprotein-Associated Disease.
Divya Alagarsamy, Thulasiraj Saminathan, Vimalraj Vijayakumar et al.
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Case in brief
A 13-year-old South Indian boy developed acute paraparesis and urinary retention, progressing to quadriparesis within a week. Spinal MRI showed longitudinally extensive transverse myelitis from D2 to D7, and brain MRI showed subcortical white matter hyperintensities. Serum testing was strongly positive for myelin oligodendrocyte glycoprotein antibodies, supporting MOG-associated disease. Functional deficits persisted after an initial course of intravenous immunoglobulin (IVIG), so IVIG was reinfused less than 2 weeks later. The patient showed marked clinical improvement within a month.
What made this case unusual
IVIG was reinfused less than 2 weeks after the initial course—shorter than the usual 3-4-week interval—because functional deficits persisted, with marked improvement reported within a month.
Diagnostic / clinical pearl
In this case of MOG-associated myelitis, persistent deficits after IVIG prompted short-interval reinfusion; the report highlights timing as a consideration in acute management when response is inadequate.