Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Presenting with Acute Paraparesis and Neurogenic Bladder: A Diagnostic Challenge in Young Adult

Abstract

Introduction: Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) presents with varied neurological features and may mimic other causes of acute myelopathy, making early diagnosis challenging. Case Presentation: A 19-year-old male presented with rapidly progressive bilateral lower-limb weakness and acute urinary retention. MRI revealed longitudinally extensive transverse myelitis from the cervical to thoracic cord, with additional thalamic and optic chiasm involvement. CSF studies supported an inflammatory etiology, and markedly positive serum MOG-IgG confirmed MOGAD. High-dose corticosteroids led to significant neurological recovery, and rituximab was initiated for relapse prevention. Conclusion: This case highlights the diagnostic challenges of atypical MOGAD presentations and emphasizes the need for early serological testing, comprehensive neuroimaging, and prompt immunotherapy to prevent long-term disability.