Abstract
A unique case of a female adolescent diagnosed with myelin oligodendrocyte glycoprotein (MOG) monophasic optic neuritis with Epstein-Barr virus (EBV) reactivation antibody profile on a remote Greek island is presented, highlighting the challenges of diagnosing rare conditions in rural settings and the importance of connecting centers of expertise with regional hospitals. The 16-year-old patient presented with progressive vision loss, headache, and retrobulbar pain in the right eye. Initial ophthalmological examinations showed decreased visual acuity and color vision deterioration. Magnetic resonance imaging (MRI) revealed optic perineuritis and edema. Cerebrospinal fluid (CSF) analysis excluded oligoclonal bands, and blood analysis was positive for both anti-MOG antibodies and EBV reactivation. Expert opinion and blood immunophenotyping confirmed the neuroimmunological condition. This case not only underscores the value of telemedicine in overcoming diagnostic challenges in rural settings but also contributes to the scientific discussion on neuroimmunological aspects and the potential role of EBV as an underlying factor in acquired demyelinating syndromes (ADS), beyond multiple sclerosis (MS).