Abstract: PUB221
Plasma Exchange for Steroid-Refractory Myelin Oligodendrocyte Antibody-Associated Disease-Associated Optic Neuritis in a 60-Year-Old Man
Session Information
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Heintze, David, Medical University of South Carolina, Charleston, South Carolina, United States
- McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
Introduction
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder that can present with optic neuritis and significant visual impairment. High-dose corticosteroids are first-line therapy, but a subset of patients do not respond and require escalation to antibody-directed therapy. Plasma exchange (PLEX), an extracorporeal therapy that removes circulating pathogenic antibodies including MOG-IgG, is used in steroid-refractory cases where rapid intervention may be critical for neurologic recovery.
Case Description
A 60-year-old man with no significant past medical history developed progressive bilateral visual changes following a recent diagnosis of MOGAD. He initially experienced left eye pain and visual field loss, which transiently improved before symptoms involved the right eye. Multiple ophthalmologic evaluations prior to admission were unrevealing. MRI of the orbits demonstrated bilateral optic perineural enhancement consistent with optic neuritis, and serum testing confirmed MOG antibody positivity (1:320).
He received intravenous methylprednisolone 1 g daily for five days without meaningful improvement. Given persistent severe visual deficits, he was transferred to our institution, where nephrology was consulted for urgent plasma exchange. A temporary central venous catheter was placed and he completed five sessions of PLEX. He was continued on prednisone 50 mg daily with a structured taper and received supportive care during hospitalization.
PLEX was well tolerated without complications. Over the course of treatment, he experienced gradual improvement in vision and color perception. At discharge approximately one month later, he was able to independently navigate a dark room with marked improvement in color vision.
Discussion
This case illustrates the role of nephrology-delivered plasma exchange as rescue therapy in steroid-refractory MOGAD-associated optic neuritis. When corticosteroid therapy fails to produce clinical improvement, timely initiation of extracorporeal antibody removal may be associated with meaningful neurologic recovery. This case shows the importance of early nephrology involvement in coordinating and delivering time-critical apheresis therapy in antibody-mediated neurologic disease.