Case report on severe myelin oligodendrocyte glycoprotein antibodyassociated disease (MOGAD) relapse after ectopic pregnancy and laparoscopic medical abortion: relevance of peripheral inflammation for demyelinating disease activity

Lidija Marija Smertinaite ¹ Katja Selin ² Roosa Vaitiniemi ^3,4 Ramojus Balevicius ^5,6 Evangelia Kollia ⁷ Tobias Granberg ^5,7 Maria Isabel Leite ⁸ Jacqueline Palace ⁹ Helene Blad ¹⁰ Virginija Karrenbauer ^11,5*

• ¹ Karolinska Institutet (KI), Solna, Stockholm, Sweden
• ² Department of Medicine, Solna, Karolinska Institutet (KI), Solna, Stockholm, Sweden
• ³ Kiruna Hospital, Kiruna, Sweden
• ⁴ Mehiläinen Länsi-Pohja Oy, Kemi, Finland
• ⁵ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden
• ⁶ Department of Microbiology and Biotechnology, Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Vilnius, Lithuania
• ⁷ Department of Neuroradiology, Karolinska University Hospital, Stockholm, Stockholm, Sweden
• ⁸ Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, England, United Kingdom
• ⁹ Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, England, United Kingdom
• ¹⁰ Nyköpings Lasarett, Department of Neurology, Nyköping, Sweden
• ¹¹ Department of Neurology, Karolinska University Hospital, Stockholm, Stockholm, Sweden

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare neurological condition. Tubal ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Regular pregnancy has a disease-modifying effect on MOGAD, with an increased relapse rate postpartum. Still, there are neither case reports nor cohort studies on abortions and ectopic pregnancy as a disease-modifying event for MOGAD.This is a case report on a severe MOGAD relapse after ectopic pregnancy and laparoscopic abortion.For the first time we described that elevated interleukin-1 (IL-1), which was found in cerebrospinal fluid in the current case may be pathogenetically related to ectopic pregnancy. Rituximab (anti-CD20 treatment), downregulated IL-1 and TNF-alfa inflammatory pathways thus is an appropriate drug of choice to treat relapse. Cytokines secreted during ectopic pregnancy could play a disease-modifying role in multiple sclerosis and Guillian-Barré syndrome.The first case report of a MOGAD severe relapse after ectopic pregnancy and laparoscopic abortion which resolved with rituximab treatment.