A rare presentation of pediatric MOG-antibody-associated neuroretinitis: a case report

Abstract

Background: Neuroretinitis (NR) is an uncommon inflammatory optic neuropathy characterized by optic disc edema and macular exudates. Although NR may arise from infectious or idiopathic causes, its association with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is exceptionally rare in children. Early recognition is critical, as MOGAD-related ocular involvement can respond favorably to prompt immunotherapy. Case presentation: We report an 11-year-old girl presenting with acute, painless visual loss in the right eye following one week of ocular pain with eye movements. Ophthalmologic evaluation revealed marked optic disc edema, splinter hemorrhages, and early macular exudation. MRI demonstrated right optic nerve thickening with T2-FLAIR hyperintensity, and optical coherence tomography showed subretinal fluid extending to the fovea. Extensive infectious testing was negative. Serum MOG-IgG was positive, supporting a diagnosis of MOGAD-associated NR. The patient received high-dose intravenous corticosteroids followed by intravenous immunoglobulin (IVIG), resulting in rapid visual improvement. A partial macular star developed during the early recovery phase. Maintenance therapy with mycophenolate mofetil was initiated due to IVIG intolerance and continued for 24 months. Over a 3-year follow-up period, the patient experienced full visual recovery without clinical relapses, although residual optic nerve thinning was observed on MRI. Conclusion: This case highlights a rare pediatric presentation of MOGAD manifesting as NR and underscores the importance of considering MOG-IgG testing in children presenting with optic disc edema and macular exudation. Early and sustained immunotherapy can lead to complete visual recovery and may reduce the risk of recurrent demyelinating episodes.