MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report

Background: Although myelin oligodendrocytes glycoprotein antibody-associated disease (MOG-AD) and anti-contactin-associated protein-like 2 (CASPR2) antibody-mediated encephalitis are distinct neurological disorders, combined existence has rarely been reported in adults. We report this rare overlap...

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Main Authors: Dona Teresa Thomas, Davidson Devasia, Jeeson Cheeran Unni, Sudheeran Kannoth, Ranjini Ramachandran
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Indian Pediatrics Case Reports
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Online Access:https://journals.lww.com/10.4103/ipcares.ipcares_12_25
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author Dona Teresa Thomas
Davidson Devasia
Jeeson Cheeran Unni
Sudheeran Kannoth
Ranjini Ramachandran
author_facet Dona Teresa Thomas
Davidson Devasia
Jeeson Cheeran Unni
Sudheeran Kannoth
Ranjini Ramachandran
author_sort Dona Teresa Thomas
collection DOAJ
description Background: Although myelin oligodendrocytes glycoprotein antibody-associated disease (MOG-AD) and anti-contactin-associated protein-like 2 (CASPR2) antibody-mediated encephalitis are distinct neurological disorders, combined existence has rarely been reported in adults. We report this rare overlap syndrome in the pediatric age group. Clinical Description: A 14-year-old girl presented with insidious onset of behavioral changes, insomnia and mental apathy worsening over 1 month, with progressive difficulty in walking, tremors of limbs, vision impairment and bladder/bowel symptoms. Bilateral ophthalmoplegia, cerebellar, and pyramidal tract signs were noted on examination. Management and Outcome: Neuroimaging and comprehensive autoimmune workup with serological testing for multiple antibodies showed features of MOG antibody-associated disease and CASPR2 encephalitis. First-line immunotherapy (pulse steroids and intravenous immunoglobulin) was initiated with marked improvement in the child. Mycophenolate mofetil was started as maintenance immunotherapy, and there was near complete resolution of the lesions at follow-up. Conclusion: This is perhaps the first report of overlap of MOG-AD and CASPR2 encephalitis in the pediatric age group, emphasizing the importance of comprehensive serological testing, including autoimmune encephalitis panel and workup for demyelinating diseases in children with multineuraxial involvement and atypical presentations.
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spelling doaj-art-dc0f8bbf2d18451d8f093f6fb7ea52712025-08-20T02:34:39ZengWolters Kluwer Medknow PublicationsIndian Pediatrics Case Reports2772-51702772-51892025-04-015211311810.4103/ipcares.ipcares_12_25MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case ReportDona Teresa ThomasDavidson DevasiaJeeson Cheeran UnniSudheeran KannothRanjini RamachandranBackground: Although myelin oligodendrocytes glycoprotein antibody-associated disease (MOG-AD) and anti-contactin-associated protein-like 2 (CASPR2) antibody-mediated encephalitis are distinct neurological disorders, combined existence has rarely been reported in adults. We report this rare overlap syndrome in the pediatric age group. Clinical Description: A 14-year-old girl presented with insidious onset of behavioral changes, insomnia and mental apathy worsening over 1 month, with progressive difficulty in walking, tremors of limbs, vision impairment and bladder/bowel symptoms. Bilateral ophthalmoplegia, cerebellar, and pyramidal tract signs were noted on examination. Management and Outcome: Neuroimaging and comprehensive autoimmune workup with serological testing for multiple antibodies showed features of MOG antibody-associated disease and CASPR2 encephalitis. First-line immunotherapy (pulse steroids and intravenous immunoglobulin) was initiated with marked improvement in the child. Mycophenolate mofetil was started as maintenance immunotherapy, and there was near complete resolution of the lesions at follow-up. Conclusion: This is perhaps the first report of overlap of MOG-AD and CASPR2 encephalitis in the pediatric age group, emphasizing the importance of comprehensive serological testing, including autoimmune encephalitis panel and workup for demyelinating diseases in children with multineuraxial involvement and atypical presentations.https://journals.lww.com/10.4103/ipcares.ipcares_12_25autoimmune encephalitisdemyelinating diseases serological testingimmunotherapy
spellingShingle Dona Teresa Thomas
Davidson Devasia
Jeeson Cheeran Unni
Sudheeran Kannoth
Ranjini Ramachandran
MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
Indian Pediatrics Case Reports
autoimmune encephalitis
demyelinating diseases serological testing
immunotherapy
title MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
title_full MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
title_fullStr MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
title_full_unstemmed MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
title_short MOG-AD and CASPR2 Encephalitis (Overlap Syndrome) in an Adolescent Girl: A Case Report
title_sort mog ad and caspr2 encephalitis overlap syndrome in an adolescent girl a case report
topic autoimmune encephalitis
demyelinating diseases serological testing
immunotherapy
url https://journals.lww.com/10.4103/ipcares.ipcares_12_25
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AT jeesoncheeranunni mogadandcaspr2encephalitisoverlapsyndromeinanadolescentgirlacasereport
AT sudheerankannoth mogadandcaspr2encephalitisoverlapsyndromeinanadolescentgirlacasereport
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