光覚消失するもステロイドが奏効した抗MOG抗体陽性視神経炎

Pulsed corticosteroid therapy was effective in a case of optic neuritis positive for antibodies against myelin oligodendrocyte glycoprotein（MOG）

要約　目的：光覚消失するもステロイド治療が奏効した抗myelin-oligodendrocyte glycoprotein（MOG）抗体陽性視神経炎の症例の報告。

症例：29歳，男性。左眼痛と視野狭窄のため近医受診し，視神経炎が疑われ当科を紹介され受診した。

所見：初診時の矯正視力は右眼1.5，左眼0.9，左眼の相対的求心性瞳孔障害を認め，左視神経乳頭は腫脹していた。MRIで左視神経の高信号と腫脹を認め，左眼に広範囲の視野欠損を認めた。初診5日目に左光覚が消失し，ステロイド投与を開始した。投与開始2日後に左光覚が出現し，4週間後には左眼矯正視力は1.0まで回復した。血液検査で抗MOG抗体陽性と判定され，抗MOG抗体陽性視神経炎と診断した。その後急性散在性脳脊髄炎を併発したためステロイド内服を継続しているが，8か月後の現在まで眼症状は悪化していない。

結論：ステロイド治療が抗MOG抗体陽性視神経炎に奏効した1例を経験した。

Abstract　Purpose：To report a case of optic neuritis who was positive for antibodies against myelin oligodendrocyte glycoprotein（MOG）and who responded to pulsed corticosteroid by recovering from the initial visual acuity of no light perception.

Case：A 29-year-old man was referred to us for suspected optic neuritis in the left eye since 3 days before. He had had bilateral paranasal sinusitis one month before.

Findings and Clinical Course：Corrected visual acuity was 1.5 in the right eye and 0.9 in the left. The left eye showed swelling of optic disc with relative afferent pupillary defect. Magnetic resonance imaging（MRI）showed swollen left optic nerve. Visual acuity in the left eye decreased to no light perception 5 days later. He started receiving pulsed corticosteroid therapy immediately. Visual acuity started to improve 2 days later and recovered to 1.0 four weeks later. He started receiving pulsed corticosteroid therapy immediately. The blood test was positive for anti-myelin oligodendrocyte glycoprotein antibody, leading to the diagnosis of anti-MOG antibody-positive optic neuritis. He developed acute disseminated encephalomyelitis 3 months later that responded to pulsed corticosteroid therapy.

Conclusion：Pulsed corticosteroid therapy was effective in the present case of optic neuritis positive for antibodies against myelin oligodendrocyte glycoprotein.