title: Influenza-associated MOG antibody-positive longitudinally extensive transverse myelitis: a case report.
abstract: BACKGROUND
  Myelin-oligodendrocyte glycoprotein antibody (MOG antibodies) was found in various demyelinated diseases. This is the first report of a patient with longitudinally extensive transverse myelitis with an extremely high titer of MOG antibodies after an influenza infection. This case supports the view that MOG antibodies are linked to longitudinally extensive transverse myelitis and that influenza infection might trigger the MOG antibodies.
  
  
  METHODS
  A 32-year-old healthy male developed high fever, dysesthesia and paraesthesia below the C2 area, muscle weakness of the bilateral lower extremities, and urinary retention ten days after an influenza type A infection. Magnetic resonance imaging revealed a longitudinal lesion in the spinal cord extending from C2 to the spinal conus. There were no lesions in the brain or optic nerves. Established cell-based immunoassays revealed that he was positive for MOG antibodies (titer = 65,536) and negative for anti-aquaporin 4 antibodies (AQP4 antibodies). He fully recovered after steroid pulse therapy followed by 60 mg prednisolone.
  
  
  CONCLUSIONS
  This is the first report of influenza A-associated longitudinally extensive transverse myelitis with a high titer anti-MOG antibodies. Our case report supports a relationship between anti-MOG antibodies and longitudinally extensive transverse myelitis, which was triggered by influenza infection. Further studies are needed to establish the clinical significance of anti-MOG antibodies for diagnosis, treatment, and prognosis.
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. cielo_colore_hr@hotmail.com.
authors.forename: Haruka
authors.initials: H
authors.lastname: Amano
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. nobu-m@juntendo.ac.jp.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Miyamoto
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. miurashimura@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimura
authors.affiliation: Department of Neurology, Tohoku University Graduate School of Medicine, Miyagi, Japan. Ddouglas.sato@med.tohoku.ac.jp.
authors.forename: Douglas Kazutoshi
authors.initials: DK
authors.lastname: Sato
authors.affiliation: Department of Neurology, Tohoku University Graduate School of Medicine, Miyagi, Japan. fujikazu@med.tohoku.ac.jp.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Fujihara
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. sueno@juntendo.ac.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ueno
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. ryonaka@juntendo.ac.jp.
authors.forename: Ryota
authors.initials: R
authors.lastname: Nakamura
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. yuji-u@juntendo.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. masao-w@juntendo-urayasu.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan. nhattori@juntendo.ac.jp.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. t_urabe@juntendo.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
mesh_terms: D000328:Adult; D001323:Autoantibodies; D006801:Humans; D009980:Influenza A virus / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology*; D009188:Myelitis, Transverse / Q000209:etiology / Q000276:immunology*
chemical_list: D001323:Autoantibodies; C571326:MOG protein, human; D063308:Myelin-Oligodendrocyte Glycoprotein