AUTHOR=Kulsvehagen Laila , Woelfle Tim , Ayroza Galvão Ribeiro Gomes Ana Beatriz , Lipps Patrick , Neziraj Tradite , Flammer Julia , Leuzinger Karoline , Derfuss Tobias , Kuhle Jens , Papadopoulou Athina , Pröbstel Anne-Katrin 

TITLE=Case report: Concurrent MOG antibody-associated disease and latent infections in two patients

JOURNAL=Frontiers in Immunology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1455355

DOI=10.3389/fimmu.2024.1455355

ISSN=1664-3224

ABSTRACT=<sec><title>Objectives</title><p>Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is frequently preceded by infections. The underlying pathomechanism, however, remains poorly understood. Here, we present the clinical data of two MOGAD patients with concurrent syphilis infection and investigate the reactivity of patient-derived antibodies to MOG and <italic>Treponema pallidum</italic> (<italic>T. pallidum</italic>).</p></sec><sec><title>Methods</title><p>Longitudinal serum samples and soluble immunoglobulins in single B cell supernatants were measured for MOG reactivity by a live cell-based assay. Reactivity against <italic>T. pallidum</italic> was assessed by enzyme-linked immunosorbent assay.</p></sec><sec><title>Results</title><p>The two patients presented MOGAD and concurrent latent syphilis infection, manifesting as cervical myelitis and unilateral optic neuritis, respectively. The first patient had been living with HIV on antiretroviral therapy, and the second was concomitantly diagnosed with chronic hepatitis B infection. Upon screening of B cell supernatants, we identified reactivity to MOG or <italic>T. pallidum.</italic> Notably, one B cell showed reactivity to both antigens.</p></sec><sec><title>Discussion</title><p>The coexistence of MOGAD diagnoses and latent syphilis, alongside the identification of antibody reactivity to MOG and <italic>T. pallidum</italic>, underscores the potential pathomechanistic link between syphilis infection and subsequent autoimmune neuroinflammation. Cross-reactivity between MOG and <italic>T. pallidum</italic> antibodies remains to be validated on a molecular level, and further characterization of infectious triggers associated with MOGAD is needed.</p></sec>