Eculizumab treatment in the salvage therapy of MOGAD: a case report.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare inflammatory demyelinating disorder of the central nervous system. During the acute phase, management typically prioritizes high-dose methylprednisolone pulse therapy. When the patients show inadequate response, intravenous immunoglobulin (IVIG) or plasma exchange is recommended. We report the case of a 17-year-old male of Mongolian ethnicity who developed severe visual impairment following treatment for Epstein-Barr virus (EBV) meningitis, ultimately diagnosed with MOGAD. Following both methylprednisolone pulse therapy and IVIG, the patient exhibited a suboptimal response. However, his symptoms improved markedly after treatment with eculizumab. Subsequently, sequential therapy with ofatumumab was applied. At the six-month follow-up, the patient remained relapse-free and reported no adverse effects. This case suggests that eculizumab can serve as an effective salvage therapy for acute MOGAD refractory to conventional treatment. Ofatumumab may be a viable option for maintenance therapy during remission. These findings may provide valuable insights for future clinical research.