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Presentation type	E-poster
Title	Paracentral Acute Middle Maculopathy: a new manifestation associated with Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD)

Purpose	We report an atypical case of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) presenting as optic neuritis with optic disc (OD) swelling, accompanied by paracentral acute middle maculopathy (PAMM).
Methods	A 41-year-old patient presented to the emergency department with a central scotoma in the right eye (RE). His medical history included bilateral optic disc swelling three years earlier of unknown etiology. At presentation, best-corrected visual acuity was 10/10 in both eyes. Visual field testing revealed a mild nasal defect in the RE and a stable inferonasal defect in the left eye (LE) from the prior episode. Peripapillary optical coherence tomography (OCT) showed bilateral optic nerve atrophy consistent with the previous event. A macular OCT was performed and revealed a thickened and hyperreflective inner nuclear layer (INL). Several days later, the patient reported decreased vision in the LE, and OD swelling associated with PAMM was observed.
Results	Because PAMM is frequently associated with cardiovascular risk factors, a complete cardiological work-up was performed and was unremarkable. Given the atypical presentation and history of OD swelling, a neuro-inflammatory workup was initiated. Anti-MOG antibodies were initially negative in both serum and CSF but became positive after retesting on diluted samples, confirming MOGAD. The patient received IV corticosteroids, followed by oral treatment and plasmapheresis, then started rituximab maintenance.
Conclusion	This case illustrates a rare presentation of MOGAD suggesting ischemic involvement of the INL. It emphasizes the importance of considering MOGAD in these cases. Repeating anti-MOG antibody testing in initially seronegative patients is warranted to treat them adequately.
Conflict of interest	No

Authors 1

Initials	M
Last name	Pegolotti
Department	CHU
City	Liège

Authors 2

Initials	AC
Last name	Chapelle
Department	CHU
City	Liège