Epidural labor analgesia in a pregnant woman with symptomatic recurrence of myelin oligodendrocyte glycoprotein antibody-associated disease: a case report.

BACKGROUND

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder that may relapse during pregnancy. The safety of neuraxial anesthesia in such patients remains unclear.

CASE PRESENTATION: We describe a 32-year-old multiparous woman with MOGAD who developed intractable hiccups due to new medullary lesions at 35 weeks of gestation. Despite steroid pulse therapy, symptoms persisted. At 36 weeks and 2 days, premature rupture of membranes occurred, and hiccups worsened with labor pain. After informed consent, labor epidural analgesia was initiated using low-concentration levobupivacaine with minimal fentanyl. Pain relief coincided with the reduction of hiccups. Vaginal delivery of a male infant was uneventful. Her hiccups resolved by postpartum day 4, and magnetic resonance imaging showed improvement in the lesion. She was discharged on postpartum day 7 without neurological worsening.

CONCLUSIONS

Labor epidural analgesia provided effective pain control and was associated with symptom relief in a parturient with active MOGAD.