Myelin oligodendrocyte glycoprotein antibody-associated disease presenting with posterior scleritis

The objective of this article is to describe an unusual presentation of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) with posterior scleritis and optic neuritis. We report the case of a 50-year-old woman who presented with acute visual deterioration, headache, and painful eye movements. Clinical examination revealed profound vision loss, optic disc edema, and posterior scleritis confirmed via B-scan ultrasound. Magnetic resonance imaging demonstrated optic nerve involvement with perineuritis, and myelin oligodendrocyte glycoprotein antibodies were detected. The patient was treated with intravenous methylprednisolone, oral steroid taper, and plasma exchange, leading to gradual vision recovery. At the 4-month follow-up, she regained functional vision with residual visual field deficits. Ancillary testing confirmed bilateral involvement, despite unilateral symptoms. This case highlights a rare manifestation of MOGAD, suggesting possible inflammatory extension into the scleral tissue. Recognizing posterior scleritis as part of the MOGAD spectrum can aid in timely diagnosis and management.