Detection of MOG-IgG and MOG-IgA in Maternal Breast Milk and Infant Blood in MOGAD: A Case Report.
Masoud Majed, Fatemeh Khani-Habibabadi, Anjali J Panicker et al.
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Case in brief
A mother with MOG antibody-associated disease had persistently elevated plasma MOG-IgG, with a transient decrease in early pregnancy. MOG-IgG and MOG-IgA were detected in both maternal plasma and breast milk; their MOG isoform and epitope binding patterns were nearly identical and limited to IgG1 and IgA1. The infant was MOG-IgG-positive at birth but remained clinically asymptomatic through 18 months while breastfeeding. In this case, detection of maternal autoantibodies in breast milk and infant blood was not accompanied by clinical disease in the infant.
What made this case unusual
MOG-IgG and MOG-IgA were found in breast milk, with nearly identical isoform and epitope binding patterns in maternal plasma and milk; the infant also tested positive for MOG-IgG at birth.
Diagnostic / clinical pearl
A positive infant MOG-IgG result at birth, in the setting of maternal MOGAD, did not correspond to clinical disease through 18 months in this case.
Why it matters
The findings suggest that maternal MOG autoantibody detection in blood and breast milk does not necessarily indicate increased risk of MOGAD in the infant.