Overlapping autoimmunity and demyelination syndromes associated with TNF inhibitor therapy

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder of the central nervous system. We describe a case of a 31-year-old male with ankylosing spondylitis who developed optic neuritis and transverse myelitis accompanied by positive anti-MOG antibodies, and subsequently features consistent with systemic lupus erythematosus (SLE), beginning 3 months after initiating adalimumab. Adalimumab was discontinued, and the patient was treated with pulsed intravenous methylprednisolone followed by rituximab with significant improvement in clinical, imaging, and laboratory manifestations of the disease. This case highlights a rare constellation of overlapping autoimmune diseases, with both MOGAD and SLE emerging after anti-TNF antibody exposure in a patient with ankylosing spondylitis.