CASE REPORT article
Front. Immunol.
Sec. Primary Immunodeficiencies
Overlapping syndrome of anti-NMDAR Encephalitis and MOG-associated disease: First African pediatric case report and literature insights
Dhouha Krir 1,2
Maha Jamoussi 1,3
Ahlem Ben Hmid 1,2,4
Hanene Ben Rhouma 1,3
Sonia Nagi 1,5
Yousr Galai 2
SAMAR SAMOUD 2,4
Hédia Klaa 1,3
Ichraf Kraoua 1,3
Imen Zamali 6,2,1,4
Mélika Ben Ahmed 1,2,4
1. Faculty of Medicine of Tunis, University of Tunis El Manar, 1068, Tunis, Tunisia
2. Department of Clinical Immunology, Pasteur Institute of Tunis, 1002, Tunis, Tunisia
3. LR18SP04, Department of Child and Adolescent Neurology, National Institute Mongi Ben Hmida of Neurology,, Tunis, Tunisia
4. Laboratory of Transmission, Control and Immunobiology of Infection, Pasteur Institute of Tunis, 1002, Tunis, Tunisia
5. Research Laboratory LR18SP04 and Neuroradiology Department, National Institute Mongi Ben Hmida of Neurology, Av. de la Rabta, 1007, Tunis, Tunisia
6. Pasteur Institute of Tunis, Tunis, Tunisia
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis pediatric cases are especially challenging due to phenotypic variability, limited literature, and the absence of standardized treatment protocols. We present the first documented African case of pediatric MOG and NMDAR overlapping syndrome (MNOS), with a review of all pediatric MNOS cases reported thus far in the literature. A previously healthy seven-year-old boy developed rapid-onset sleep disturbances, neuropsychiatric symptoms, multiple cranial nerve palsies, and hyperkinetic movements. Serological and cerebrospinal fluid (CSF) analyses confirmed dual positivity for anti-MOG and anti-NMDAR antibodies. The patient responded favorably to first line immunotherapy with intravenous immunoglobulin and corticosteroids, showing marked clinical i m p r o v e m e n t by the six-month follow-up. A corticosteroid taper was initiated thereafter. At fourteen-month follow-up, he had a second episode with a MOGAD-associated cerebral cortical encephalitis phenotype. Antibody screening confirmed persistent dual positivity for both anti-NMDAR and anti-MOG antibodies. The clinical outcome was favorable following first-line immunotherapy combined with oral immunosuppressants. This case highlights the uniqueness of this entity, where antibody dynamics are closely tied to the clinical course.
Summary
Keywords
Anti-N-methyl-D-aspartate receptor, autoimmune neurological disorders, MNOS, myelin oligodendrocyte glycoprotein, Overlapping syndrome
Received
28 August 2025
Accepted
04 February 2026
Copyright
© 2026 Krir, Jamoussi, Ben Hmid, Ben Rhouma, Nagi, Galai, SAMOUD, Klaa, Kraoua, Zamali and Ben Ahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Imen Zamali
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.