Myelin oligodendrocyte glycoprotein antibody-positive optic neuritis with considerable white blood cell elevation in cerebrospinal fluid

We present a case with an atypical presentation of myelin oligodendrocyte glycoprotein associated disease (MOGAD) presenting with optic neuritis, short-segment transverse myelitis, and significant lymphocytic pleocytosis. The degree of lymphocytic pleocytosis in this case was unusually high and prompted extensive workup. Broad infectious and neoplastic work-up was unremarkable and raised the concern for aseptic meningitis. A literature review was performed of similar cases with documented CSF labs (see Table 1), which demonstrates the unique and significant pleocytosis noted in this case.