Of these 15 cases, there has only been 1 pediatric case involving a 13-month-old female patient with an MOG antibody ( 6). So far, there have been 15 cases of ADEM and acute hemorrhagic leukoencephalitis (AHLE) after COVID-19 infections occurring mainly in adults. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a newly identified disease entity that was initially identified mainly in pediatric cases of acute disseminated encephalomyelitis (ADEM), usually in postvaccination or postinfectious circumstances ( 4, 5). To date, only several cases of central nervous system (CNS) demyelinating disease occurring after mRNA vaccinations have been reported ( 3). The common adverse events of the mRNA-1273 vaccine are considered mild, which include transient headache, pain, muscle spasms, and myalgia ( 2). The mRNA-1273 vaccine, which was developed by Moderna and the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), has demonstrated tremendous clinical efficacy and safety against COVID-19 ( 2). The second case was determined not to be related to the vaccination as this individual received a placebo vaccine ( 1). The remaining 2 cases were determined to be unlikely related to vaccinations as the first case occurred 10 days after the individual received a first vaccine dose and the individual had a preexisting unrecognized condition of multiple sclerosis (MS). In this particular trial, 3 cases of transverse myelitis occurred, of which 1 case was determined to be possibly related to the vaccination as this case occurred 14 days after a ChAdOx1 nCoV-19 second booster vaccination. In particular, the ChAdOx1 nCOV-19 vaccine has shown an acceptable safety profile and has demonstrated a 62.1–90% efficacy reduction in COVID-19 infections in a clinical trial involving 23,848 participants ( 1). To overcome the unprecedented effects of the pandemic, there was a rapid global effort to develop several vaccines against SARS-CoV-2, which resulted in several safe and efficacious immunogenic vaccines including ChAdOx1 nCOV-19 and mRNA-1273 ( 1, 2). The emergence in December 2019 of a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had devastating global consequences. Although the appearance of MOG antibodies is relatively rare in post-COVID-19–vaccine demyelinating diseases, MOGAD should be considered in patients with central nervous system (CNS) demyelinating diseases after receiving a SARS-CoV-2 vaccine. To date, there have only been two cases of monophasic MOGAD following SARS-CoV-2 vaccination, including both the ChAdOx1 nCOV-19 and mRNA-1273 vaccines, and the prognosis is generally similar to other typical MOGAD cases. After two courses of intravenous methylprednisolone treatment, the patient's symptoms improved and her cerebellar peduncle lesion shrunk slightly without gadolinium enhancement. The patient was diagnosed with MOGAD after receiving an mRNA SARS-CoV-2 vaccination. Tests for soluble interleukin (IL)-2 receptors in the serum, IL-6 in the CSF and skin pricks, and angiotensin converting enzyme tests were all unremarkable. The patient's serum test results for cytoplasmic-antineutrophil cytoplasmic antibodies, perinuclear-cytoplasmic-antineutrophil cytoplasmic antibodies, GQ1b-antibodies, and aquaporin-4 antibodies (AQP4-IgG) were all negative. Laboratory workups were positive for serum MOG-IgG as assessed by live cell-based assays and the presence of oligoclonal bands in the cerebrospinal fluid (CSF). Other neurological examinations were unremarkable. A neurological examination revealed paresthesia on her right V2 and V3 areas. The patient's brain MRI revealed a right cerebellar peduncle lesion with gadolinium enhancement, a typical finding of MOGAD. A previously healthy 68-year-old woman presented to our department with gradually worsening numbness on the right side of her face, which began 14 days after her second dose of an mRNA-1273 vaccination. Here we report a case of MOGAD after mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) is a newly identified autoimmune demyelinating disorder that is often associated with acute disseminated encephalomyelitis and usually occurs postinfection or postvaccination. 3Department of Neurology, National Hospital Organization Yonezawa Hospital, Yonezawa, Japan.2Department of Neurology, Tohoku University Hospital, Sendai, Japan.1Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.Yuki Matsumoto 1 Ayane Ohyama 2 Takafumi Kubota 2 Kensuke Ikeda 2 Kimihiko Kaneko 2 Yoshiki Takai 2 Hitoshi Warita 2 Toshiyuki Takahashi 3 Tatsuro Misu 2 * Masashi Aoki 1,2
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