Recently, the team from Department of Neurology of the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) successfully treated a rare case of MOG antibody-associated disease (MOGAD) complicated with breast cancer and pulmonary cryptococcosis. A 61-year-old patient, surnamed Shi, had the onset of the left limb weakness and numbness and presented with the sequelae of decreased vision in bilateral eyes. Serum MOG antibody was tested strong positive. Imaging examination revealed T2-FLAIR-mismatch sign. The patient was diagnosed with MOGAD recurrence. She had a medical history of breast cancer. Chest CT scan showed pulmonary nodules, which were confirmed as Cryptococcus neoformans infection by biopsy and serological results. According to literature review, less than 100 cases of neuroimmune disease complicated with malignant tumors and cryptococcal infection have been reported worldwide.

The patient was admitted to the sub-specialist ward of rare immunoneurological diseases in Land Port Division. Professor Dang Jingxia and physician Qin Xing from Department of Neurology launched multidisciplinary team (MDT) diagnosis and treatment. In terms of neuroimmunity, "sequential immunotherapy" was adopted by first delivering immunoglobulin shock therapy, followed by rituximab to eliminate pathogenic B cells. Department of Oncology suggested continual use of chemotherapy drugs and avoided immune checkpoint inhibitors. Department of Respiratory Medicine recommended use of fluconazole as consolidation treatment of pulmonary cryptococcus, and monitoring drug interaction, pulmonary nodules and serum cryptococcus indexes throughout the treatment.

After more than 1-month comprehensive treatment, remarkable efficacy was observed. Muscle strength was recovered from grade II to grade IV, and the score of Extended Disability Status Scale (EDSS) was decreased from 8 to 6.5. The condition of breast cancer was stable, the serum cryptococcal capsular antigen was tested from positive to weakly positive, and the size of pulmonary nodules was reduced. At present, fluconazole is given regularly for antifungal purpose.

Successful treatment of this rare and complicated case highlights the capability of Department of Neurology in precise diagnosis and treatment of rare neuroimmune diseases and the key role of MDT in the treatment of complicated and severe diseases.