Myelin oligodendrocyte glycoprotein antibody-associated disease after transforaminal lumbar interbody fusion surgery: a case report.

Abstract

Background: Postoperative myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) represents a rare clinical entity that poses significant diagnostic challenges. Despite its clinical relevance, limited attention has been directed toward postoperative MOGAD, compounded by its heterogeneous symptom presentation and potential mimicry of other postoperative complications. This case study provides critical insights into the diagnostic and therapeutic management of postoperative MOGAD, emphasizing the necessity for early recognition and appropriate treatment. We present a case of a 27-year-old female who developed refractory fever following transforaminal lumbar interbody fusion (TLIF) surgery. Initial treatment focused on suspected surgical site inflammation, with empirical broad-spectrum antibiotics administered. However, progressive neurological manifestations including bilateral vision impairment, headache, and positive serum MOG-IgG prompted revision of the diagnosis to MOGAD. The patient subsequently received targeted therapy and recovered well.

Results: The patient received methylprednisolone, mannitol, and intravenous immunoglobulin therapy. This regimen achieved complete neurological recovery, with resolution of visual deficits and normalization of inflammatory markers.

Conclusion: This case highlights the importance of identifying postoperative MOGAD as a potential complication and underscores the need for early and accurate diagnosis. Increased awareness and prompt intervention could prevent unnecessary delays in treatment and improve patient prognosis.