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Background <p>Anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated encephalitis is increasingly recognized in children, but severe forms requiring PICU admission are rarely described especially in resource-limited settings.</p> Objective <p>To describe the clinical presentation, laboratory findings, neuroimaging features, and outcomes of children with ELISA-confirmed serum anti-MOG antibody-positive encephalitis requiring admission to the pediatric intensive care unit (PICU).</p> Methods <p>Retrospective chart review of 13 pediatric patients admitted to the PICU at Zagazig University Hospital between January and November 2024 who (1) fulfilled Banwell et al. (2023) clinical criteria for possible MOGAD, (2) tested positive for serum anti-MOG antibodies via ELISA, and (3) had complete clinical, laboratory, and neuroimaging data available.</p> Results <p>Median age: 0.83 years (range: 5 months–8 years); M: F = 7:6. All presented with fever &gt; 38.5 °C, and encephalopathy; 12/13 with seizures; 10/13 with autonomic dysfunction; 9/13 with shock. Laboratory findings: universal lymphopenia, elevated CRP, D-dimer, ferritin, AST, and troponin. CSF pleocytosis in 9/13 tested (median 10 cells/μL). MRI available in 10 patients: basal ganglia/thalamus in 5/10, brainstem in 5/10, cortical grey matter in 3/10. Outcomes: 5/13 patients died, 5/13 survived with severe disability, and 3/13 achieved good neurological recovery. All patients with brainstem involvement experienced poor outcomes.</p> Conclusion <p>In the PICU setting, probable anti-MOG encephalitis in infants and toddlers is characterized by a fulminant course with shock and brainstem involvement, and high mortality. Early immunotherapy is critical. Brainstem involvement on MRI was observed in all patients with poor outcomes, suggesting this may represent an important prognostic marker.</p>

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Severe pediatric anti-MOG antibody positive encephalitis in the PICU: clinical, laboratory, and neuroradiological features of 13 cases, a single-center Egyptian series

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  • 发表日期：

    2026年3月6日

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  • Zienab Ahmed Fouad Mohamed Abu-Zied,
  • Dalia A. Abdelrahman,
  • Ayman Marei,
  • Mohamed Ragab Abdellatif Mohamed

摘要

Background

Anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated encephalitis is increasingly recognized in children, but severe forms requiring PICU admission are rarely described especially in resource-limited settings.

Objective

To describe the clinical presentation, laboratory findings, neuroimaging features, and outcomes of children with ELISA-confirmed serum anti-MOG antibody-positive encephalitis requiring admission to the pediatric intensive care unit (PICU).

Methods

Retrospective chart review of 13 pediatric patients admitted to the PICU at Zagazig University Hospital between January and November 2024 who (1) fulfilled Banwell et al. (2023) clinical criteria for possible MOGAD, (2) tested positive for serum anti-MOG antibodies via ELISA, and (3) had complete clinical, laboratory, and neuroimaging data available.

Results

Median age: 0.83 years (range: 5 months–8 years); M: F = 7:6. All presented with fever > 38.5 °C, and encephalopathy; 12/13 with seizures; 10/13 with autonomic dysfunction; 9/13 with shock. Laboratory findings: universal lymphopenia, elevated CRP, D-dimer, ferritin, AST, and troponin. CSF pleocytosis in 9/13 tested (median 10 cells/μL). MRI available in 10 patients: basal ganglia/thalamus in 5/10, brainstem in 5/10, cortical grey matter in 3/10. Outcomes: 5/13 patients died, 5/13 survived with severe disability, and 3/13 achieved good neurological recovery. All patients with brainstem involvement experienced poor outcomes.

Conclusion

In the PICU setting, probable anti-MOG encephalitis in infants and toddlers is characterized by a fulminant course with shock and brainstem involvement, and high mortality. Early immunotherapy is critical. Brainstem involvement on MRI was observed in all patients with poor outcomes, suggesting this may represent an important prognostic marker.