Recurrent Optic Neuritis With MRI-Negative Myelopathy in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disorder that frequently presents with optic neuritis or myelitis, although early diagnostic evaluation may be challenging when neuroimaging is normal despite significant neurological deficits. We describe a 29-year-old woman who initially developed unilateral optic neuritis, followed one month later by sequential contralateral involvement and new sensory disturbances. She subsequently presented with acute bilateral lower-limb weakness, brisk reflexes, and lumbosacral sensory disturbance, although spinal MRI remained normal. Progressive neurological decline prompted treatment with high-dose IV corticosteroids and plasma exchange. MOG-IgG later returned positive, confirming MOGAD. The patient experienced gradual recovery of left-eye color perception and lower-limb strength, whereas right-eye visual acuity remained profoundly reduced. This case underscores the importance of recognizing recurrent or bilateral optic neuritis as a potential harbinger of MOGAD, appreciating that clinically evident myelopathy may occur with normal MRI, and initiating early neurology involvement and treatment escalation to prevent irreversible disability.