MOG Antibody Disease (MOGAD) Presenting as Acute Disseminated Encephalomyelitis (ADEM): Insights from Cerebrospinal Fluid Cytokine Profiling

This study reports a pediatric case of MOG - antibody associated disease (MOGAD) presenting as acute disseminated encephalomyelitis (ADEM) following a febrile episode. The patient, a 6-year-old female, exhibited progressive neurological deficits that resolved after treatment with intravenous corticosteroids. We characterized the cerebrospinal fluid (CSF) inflammatory profile, which revealed significant elevations of pro-inflammatory cytokines, including TNF, IL-6, IL-8, and IL-1β. In contrast, the anti-inflammatory cytokine IL-10 was also markedly increased, suggesting an endogenous mechanism to limit the inflammatory cascade. The robust neuroinflammatory response, combined with the favorable clinical outcome after immunosuppression, highlights the complex response of pro- and anti-inflammatory pathways in MOGAD. Our findings reinforce the potential of CSF cytokine profiling to advance the understanding of the immunopathogenesis of MOGAD and to guide personalized therapeutic interventions, particularly with agents targeting key mediators.