Article type: Case Report and Literature Review
Article title: Myelin Oligodendrocyte Glycoprotein G Antibody-Positive Paraneoplastic Myelopathy in Seminoma: A Case Report and Literature Review
Journal: The Neurohospitalist
Year: 2024
Authors: Umair Hamid, Jamir Pitton Rissardo, Luisa F. Alviz, Ana Letícia Fornari Caprara, and Tiffani S. Franada
E-mail: jamirrissardo@gmail.com
ABSTRACT
Myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) are autoimmune diseases that often manifest in the context of infections. They can also arise less commonly following vaccination but even more rarely in a paraneoplastic context. Herein, we will report a patient presenting with subacute inflammatory myelopathy after a fourth dose of the mRNA COVID-19 vaccine. Concurrently, a diagnosis of MOGAD was made with a metastatic abdominal seminoma. The patient was acutely treated with high-dose steroids followed by plasma exchange therapy and was subsequently started on a chemotherapy regimen for the underlying germ cell tumor. The patient had a complete resolution of neurological symptoms upon the last follow-up. Overall, 72 cases of COVID-19 vaccination associated with MOGAD were analyzed (median age at onset 39 years old; female to male ratio = 1.2:1). All cases occurred in adults except for an adolescent, with the majority occurring after vaccination with ChAdOx nCoV-19 (87%), and an average temporal profile between vaccination and symptom onset of 19 days. There were no reported cases after the third or fourth doses, and most patients were diagnosed with new-onset MOGAD after their first vaccine (76%). Although COVID-19 vaccination could be a potential causality, there are significant discrepancies between the reported cases and this patient, alongside the unlikely causality assessment obtained with the Bradford Hill criteria. Vaccination could unmask potential pre-existing autoimmune diseases, such as in this patient, where myelopathy was most likely part of a paraneoplastic syndrome associated with a newly diagnosed seminoma.
Keywords: seminoma, germ cell tumor, myelin oligodendrocyte glycoprotein-associated disorders, demyelinating, transverse myelitis, paraneoplastic myelopathy, anti-myelin oligodendrocyte glycoprotein, Coronavirus Disease 2019 vaccination.
Full text available at:
DOI
Citation
Hamid U, Pitton Rissardo J, Alviz LF, Fornari Caprara AL, Franada TS. Myelin Oligodendrocyte Glycoprotein G Antibody-Positive Paraneoplastic Myelopathy in Seminoma: A Case Report and Literature Review. Neurohospitalist 2024;15:195–201.
Figure 1. Sagittal (A and B) and axial (C and D) views of the thoracic and lumbar spine magnetic resonance imaging showing enhancing T2 hyperintense mildly expansile lesion involving the central and right lateral spinal cord at T5-T6. The area of T2 signal hyperintensity measures up to 2.4 cm in length. There is a nodular enhancing component measuring 1.3 cm in length along the right lateral aspect of the spinal cord.
Figure 2. Axial (A) and coronal (B) views of the abdomen computed tomography scans with IV contrast showing a large retroperitoneal mass. It measures 15 cm in transverse dimension, 11 cm in anterior-posterior dimension, and 14 cm in craniocaudal dimension. The mass displaces the left kidney
Table 1. Demographic Characteristics of Reported Cases and the Temporal Profile Between Vaccination and Onset of Symptoms.
Table 2. Type of Vaccine, its Dose, and Clinical Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.