A 66-Year-Old Woman Presented with Sudden Onset Eye Pain and Loss of Vision: Do Not Miss MOGAD

A 66 -year- old woman presented to ED with sudden onset eye pain and unilateral loss of vision. She had considerable vascular risk factors including age, hypertension, diabetes mellitus and hypercholesterolemia. She was referred to neurology service with possible arteritic anterior ischemic optic neuropathy (AION). Given her age, painful visual loss and raised ESR, she was treated with steroids for possible giant cell arteritis (GCA). Because of her psychiatric history and poorly controlled diabetes mellitus, steroids were weaned quickly. 6 months later, she had a similar presentation affecting the other eye. MRI head showed disease progression with positive myelin oligodendrocyte glycoprotein (MOG) antibody in serum. MOG associated disorder (MOG-AD) is a steroid responsive inflammatory demyelinating disease but needs long term immunosuppression plan and monitoring of serum antibody.