Successful Treatment of Refractory Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease With Tocilizumab: A Case Report and Literature Review

ABSTRACT Background Approximately half of patients with myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease (MOGAD) experience relapses, and optimal relapse‐prevention strategies remain under discussion. The interleukin‐6 (IL‐6) signaling pathway plays a pivotal role in MOGAD pathogenesis, and its inhibition has been proposed as a promising therapeutic approach. Case Presentation We describe an 18‐year‐old male with refractory MOGAD characterized by multiple MRI‐detected lesions showing an acute disseminated encephalomyelitis (ADEM)‐like pattern, whose condition dramatically improved with tocilizumab. His symptoms included fever, headache, nausea, paresthesia, moria, somnolence, and seizure. Despite multiple courses of intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin, his condition remained uncontrolled. Weekly subcutaneous administration of tocilizumab, a monoclonal antibody against the IL‐6 receptor, resulted in marked clinical and radiological improvement and sustained disease stabilization. Conclusions This case highlights the potential of IL‐6 receptor inhibition with tocilizumab as an effective treatment strategy for refractory MOGAD.