Development of MOGAD in a Patient with Granulomatosis with Polyangiitis and Giant Cell Arteritis Overlap Syndrome
Bibliographic record
Abstract
Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare CNS autoimmune disorder. Characterized by antibody-mediated demyelination, a common initial manifestation is visual disturbance and vision loss due to optic neuritis. In this unique case study, we present a rare instance of MOGAD-related visual changes in a patient with an established history of both GPA (granulomatosis with polyangiitis) and GCA (giant cell arteritis) (Figure 1). Case A 77-year-old male with GCA with PMR and GPA (both in remission) presented in May 2024 with new-onset left eye pain with reduced vision and visual white out immediately following scheduled cataract surgery. He was seen by ophthalmologists who suspected optic neuritis with MRI showing enhancement of the left optic nerve. CTA head was normal. He was initiated on methylprednisolone 1g IV for 3 days and his vision recovered to baseline by day 3 of therapy. He was continued on a course of prednisone 30mg po qd. Due to the atypical nature of his presentation, MOG and NMO antibodies were sent. MOG antibody returned as highly positive which suggested MOGAD After Rheumatology review, there was no evidence of vasculitis flare. He was continued on prednisone without relapsing with a gradual taper over 3 months. Conclusion Isolated case reports exist for MOGAD presentation in patients with GCA or GPA uniquely, but to our knowledge there has been no report of MOGAD in a patient with both forms of vasculitis. While no treatment guidelines exist for MOGAD, it is highly responsive to steroid therapy. While there are no Health Canada approved maintenance therapies for MOGAD, immunomodulation is recommended if there is disease recurrence or high-risk disease features. This patient is currently on methotrexate for GCA/PMR remission maintenance which has some evidence of efficacy for MOGAD and GPA. Stronger immunosuppression is limited due to a recent diagnosis of prostate cancer and previous cancer history (IPMN, SCC).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".