Beyond MOG and AQP4 Antibodies: Alternative Causes of Optic Neuritis

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file:///home/jlgarcia/Downloads/Preprints202310.0148.v1.pdf

Abstract:

Optic neuritis (ON) is the most common cause of vision loss in young adults.

It manifests as acute or subacute vision loss, often accompanied by retrobulbar discomfort or pain on eye movements. Typical ON is associated with Multiple Sclerosis and is generally mild and steroid responsive, whereas atypical forms are characterized by unusual features, such as optic disc edema, poor treatment response and bilateral involvement, and are often associated with autoantibodies against aquaporin-4 (AQP4) and Myelin Oligodendrocyte Glycoprotein (MOG).

However, in rare cases AQP4 and MOG antibodies will come back negative, plunging the clinician in a diagnostic conundrum. Seronegative ON warrants a broad differential diagnosis, including autoantibody associated, granulomatous, and systemic disorders.

These rare forms need to be identified promptly, as their management and prognosis is greatly different.

The scope of this review is to describe possible, rarer etiologies of ON when AQP4 and MOG antibodies are negative and discuss their diagnosis and treatment.