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MOG Antibody-Associated Disease in the Setting of Metastatic Melanoma Complicated by Immune Checkpoint Inhibitor Use.
Syc-Mazurek, Stephanie B; Zhao-Fleming, Hannah; Guo, Yong; Tisavipat, Nanthaya; Chen, John J; Zekeridou, Anastasia; Kournoutas, Ioannis; Orme, Jacob J; Block, Matthew S; Lucchinetti, Claudia F; Mustafa, Rafid; Flanagan, Eoin P.
Affiliation
  • Syc-Mazurek SB; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Zhao-Fleming H; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Guo Y; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Tisavipat N; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Chen JJ; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Zekeridou A; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Kournoutas I; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Orme JJ; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Block MS; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Lucchinetti CF; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Mustafa R; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
  • Flanagan EP; From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin.
Neurol Neuroimmunol Neuroinflamm ; 11(4): e200249, 2024 Jul.
Article in En | MEDLINE | ID: mdl-38696737
ABSTRACT

OBJECTIVES:

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disease rarely associated with malignancy. We report the clinical, MRI, immunopathology, and treatment response in a person with MOGAD and melanoma.

METHODS:

This is a case report of a person with a multidisciplinary evaluation at a tertiary referral center.

RESULTS:

A 52-year-old man presented with progressive encephalomyelitis that led to identification of metastatic melanoma. Investigations revealed positive MOG-IgG at high titers in serum (11,000; normal, <120) and CSF (14,096; normal, <12). MRI demonstrated multifocal T2 lesions with enhancement in the brain and spine. Brain biopsy showed demyelination and inflammation. MOG immunostaining was not present in the tumor tissue. He initially improved with methylprednisolone, plasmapheresis, prolonged oral steroid taper, and cancer-directed treatment with BRAF and MEK 1/2 inhibitors, but then developed bilateral optic neuritis. IV immunoglobulin (IVIG) was initiated. Five months later, he developed metastases and immune checkpoint inhibitor (ICI) treatment was started, which precipitated optic neuritis and myelitis despite IVIG and prednisone. Tocilizumab, an interleukin-6 receptor blocker, was started with excellent and sustained clinical and radiologic response.

DISCUSSION:

This case revealed a presentation of MOGAD concurrent with melanoma without tumor MOG immunostaining. We highlight tocilizumab as a dual-purpose treatment of MOGAD and the neurologic immune-related adverse effect of ICI.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Myelin-Oligodendrocyte Glycoprotein / Immune Checkpoint Inhibitors / Melanoma Limits: Humans / Male / Middle aged Language: En Journal: Neurol Neuroimmunol Neuroinflamm / Neurol. neuroimmunol. neuroinflamm / Neurology© neuroimmunology & neuroinflammation Year: 2024 Document type: Article Country of publication:
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Myelin-Oligodendrocyte Glycoprotein / Immune Checkpoint Inhibitors / Melanoma Limits: Humans / Male / Middle aged Language: En Journal: Neurol Neuroimmunol Neuroinflamm / Neurol. neuroimmunol. neuroinflamm / Neurology© neuroimmunology & neuroinflammation Year: 2024 Document type: Article Country of publication: