PROLONGED FEVER - AN ATYPICAL PRESENTATION IN MOG ANTIBODY ASSOCIATED DISORDERS

Abstract We report 12 cases of MOG-Ab Associated Disorders (MOGAD) who all manifested prolonged fever (PF) lasting several weeks during the course of the illness. Eight of these had no clinical /imaging evidence of demyelination until much later. Three clinical presentations were: fever of unknown origin (4 /12), aseptic meningitis (4/12) and PF along with established acute demyelination syndrome (4/12). Leukocytosis, and raised inflammatory markers along with CSF pleocytosis were almost universal. The first two presentations frequently caused diagnostic confusion, as MOGAD was not considered until several weeks after disease onset. The third group was more a therapeutic conundrum on how to manage the PF. Early seizures without encephalopathy were not uncommon and were probably independent of the later-appearing demyelination. This case-series highlights that pediatric MOGAD seems to have prolonged fever as a common and potentially confusing manifestation in it’s symptom complex. The latter should be included in the differential diagnosis of these atypical presentations.