Flower and Burring Threads

There is documentation showcasing a link between T-cell lymphoma and antibody-mediated encephalitis or optic neuritis. One case of Myelin oligodendrocyte glycoprotein (MOG) associated encephalomyelitis (MOG-EM) with concomitant T-cell lymphoma has been reported per literature review. There were no cases of MOG optic neuritis with concomitant T-cell lymphoma reported. Here, we have a case of a patient with T-cell lymphoma with relapsing anti-MOG optic neuritis.

Poster 112 Flower and Burring Threads Alexis Pascoe1, Amina Chaudhry2, Andrew Whyte2, Nagham Al-Zubidi2 1 University of Texas Medical Branch, Galveston, USA, 2MD Anderson Cancer Center, Houston, USA Introduction: There is documentation showcasing a link between T-cell lymphoma and antibody-mediated encephalitis or optic neuritis. One case of Myelin oligodendrocyte glycoprotein (MOG) associated encephalomyelitis (MOG-EM) with concomitant T-cell lymphoma has been reported per literature review. There were no cases of MOG optic neuritis with concomitant T-cell lymphoma reported. Here, we have a case of a patient with T-cell lymphoma with relapsing anti-MOG optic neuritis. Description of Case(s): A 27- year -old male with the past medical history of T-cell lymphoma status-post chemoradiation therapy and stem-cell transplantation presented with acute visual field loss in the right eye (OD) while battling hemorrhagic cystitis. On examination, visual acuity (VA) was 20/400 OD and 20/25 left eye (OS). right RAPD, H.H.R. color vision 0/14 OD, 10/14 (OS). Confrontational visual field revealed central scotoma OD. Anterior segment and sensory motor examination were unremarkable. Dilated fundus exam revealed Frisen III optic disc edema OD. An MRI orbit with and without contrast showed enhancement of the right optic nerve, consistent with optic neuritis OD. Bloodwork was positive for Myelin oligodendrocyte glycoprotein (MOG) antibodies. Three weeks later, Humphry visual field revealed a new visual field defect OS. Repeat MRI orbit demonstrated decreased right optic nerve enhancement and a new enhancement of the left optic nerve. Conclusions, including unique features of the case(s): In this clinical context, one must see if it is related to the cancer, the side effect of the treatment, or new diagnosis. In this case, consideration was given to the possibility that this new diagnosis was associated with T-cell lymphoma. This connection was attributed to dysregulated adaptive immunity caused by the lymphoma rather than an induced introduction of the antigen. In conclusion, we firstly report a case of anti- MOG sequential bilateral optic with concomitant T-cell lymphoma. References: Zaenker, P., Gray, E.S., Ziman, M.R., 2016. Autoantibody production in cancer-the humoral immune response toward autologous antigens in cancer patients. Autoimmun Rev 15, 477–483. https://doi.org/10.1016/j.autrev.2016.01.017 Kwon YN, Koh J, Jeon YK, Sung JJ, Park SH, Kim SM. A case of MOG encephalomyelitis with T- cell lymphoma. Mult Scler Relat Disord. 2020 Jun;41:102038. doi: 10.1016/j.msard.2020.102038. Epub 2020 Mar 2. PMID: 32155461 Keywords: optic neuritis, optic neuropathy, demeylinating disease, tumors Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: None provided. 176 | North American Neuro-Ophthalmology Society