The patient was treated with 1 gm I/v once daily methylprednisolone for five days, following which he started showing signs of recovery on the fifth day, followed by tapering dosages of oral steroids over eight weeks. Also, the presence of anti-spike protein COVID-19 antibodies and recent administration of vaccine hints toward a possibility of vaccine-associated MOGAD. The absence of oligoclonal bands, MRI pictures, and CSF findings with strongly positive IgG anti-MOG antibodies points toward anti-MOG antibody syndrome. ![]() Reverse transcript (RT) COVID-19 polymerase chain reaction (PCR) was negative in the nasopharyngeal swab. Levels of anti-spike protein COVID-19 antibodies were elevated. Evoked potentials like VER and BAER were within normal limits. IgG anti-MOG antibodies were strongly positive in serum. Aquaporin-4 antibodies were negative in both CSF and serum. Similarly, all stains, cultures, and malignant cells were negative. The examination for oligoclonal bands in CSF, the pan neurotropic viral panel, and the Bio-fire panel was negative for all common bacteria, viruses, and fungi. Cerebrospinal fluid (CSF) examination showed a raised lymphocytic count of 184/mm 3 with a slight increase in protein level - 88mg/dl. Serum venereal disease research laboratory (VDRL), antinuclear antibody (ANA), cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA), perinuclear antineutrophil cytoplasmic antibody (P-ANCA), hepatitis B, hepatitis C, and HIV were negative, and angiotensin-converting enzyme (ACE) levels were normal. General physical examination was unremarkable. The possibilities of acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody disease, post-viral demyelination, post vaccinal demyelination, connective tissue disorders like systemic lupus erythematosus (SLE), vasculitis, and neuro-sarcoidosis were considered. Long segment of hyperintense signal C3-C6 is seen in the cervical cord on sagittal T2W images None of the lesions showed contrast enhancement. It showed hyperintensities in bilateral middle cerebellar peduncles and pons (Figure (Figure1, 1, ,2) 2) and hyperintense signals from C3 to C6 levels in the spine (Figure (Figure3). MRI of the brain and spine was performed. All reflexes were brisk, and Babinski's reflex was extensor. In addition, the patient had urinary retention, for which catheterization was done. The power was grade 2/5 proximally and grade 3/5 distally in both upper and lower limbs), with diminished touch, pain, and vibration below C4 dermatome level. On examination, the patient had complete paralysis of both upper and lower limbs. ![]() There was no history suggestive of connective tissue disorder, viral illness, trauma, or dog bite in the past. He had never had any similar episode in the past. ![]() The patient gave a history of his first dose of ChAdOx1 nCoV-19 coronavirus vaccination 20 days before all his symptoms started. No history of diplopia, decreased visual acuity, difficulty in swallowing, chewing, and breathing difficulty. He had a reduced sensation of pain and touch below the level of C4. On the third day of illness, the patient complained of urinary retention. A 26-year-old male presented to emergency with chief complaints of progressive bilateral upper and lower limb weakness for the past two days.
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