Multiple Sclerosis Journal最新文献

Baló's concentric sclerosis (BCS) is regarded as a rare variant of multiple sclerosis (MS), characterised by multi-layered ring-like lesions in cerebral white matter. Despite pathological overlap with MS, the effect of treatment with MS disease-modifying therapies remains unclear. The only extant case report of alemtuzumab in BCS described a lack of clinical response in a patient who had previously not responded to corticosteroids, plasmapheresis and cyclophosphamide. The authors speculated that alemtuzumab may have been effective if started earlier in the disease process. We present the outcomes of a patient with BCS who responded clinically and radiologically to alemtuzumab over a 6-year follow-up.

Background: Progressive multifocal leukoencephalopathy (PML) has not been reported in pediatric neuromyelitis optica spectrum disorder (NMOSD) and rarely described in children.

Objectives: To report a case of PML in childhood-onset NMOSD.

Methods: A single retrospective case report.

Results: Nine years after diagnosis of aquaporin-4 antibody positive NMOSD, a 17-year-old boy treated with rituximab presented with painless right visual loss over 6 weeks coinciding with CD19 repopulation. Acute relapse treatment was given but he continued to deteriorate, and JC virus was detected in cerebrospinal fluid confirming PML.

Conclusion: PML can occur in childhood-onset NMOSD and protracted clinical presentations with unusual radiological features should prompt JCV testing. Balancing effective immunosuppression while mitigating the risks of associated complications in long-term relapsing conditions remains a challenge.

Background: The full range of side effects of disease-modifying treatment for multiple sclerosis (MS) remains to be determined. To date, four serious varicella zoster virus (VZV) infections have been reported in association with dimethyl fumarate (DMF).

Report: A 44-year-old man on DMF for relapsing remitting MS presented with monocular pain and visual impairment. Ophthalmological examination revealed panuveitis with arteritis, retinitis and vitritis. Vitreous PCR was positive for VZV confirming the clinical impression of acute retinal necrosis (ARN).

Discussion: ARN due to VZV may mimic optic neuritis in people on disease-modifying therapy for MS.

An 80-year-old man with aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder presented with a 2-week history of cough and hiccups, followed by progressive bilateral lower limb weakness, a bandlike burning sensation in the upper body, and urinary retention. Magnetic resonance imaging showed area postrema and thoracic central medullary lesions. Thorax computed tomography showed bilateral upper lung lobe consolidations. Lung biopsy confirmed organizing pneumonia. Immunohistochemistry of these lesions demonstrated aquaporin-4 loss, immunoglobulin G-binding, and complement deposits, akin to central nervous system lesions found in neuromyelitis optica spectrum disorder. Thus, aquaporin-4-antibodies may be involved in extra-central nervous system manifestations of neuromyelitis optica spectrum disorder.

Background: B-cell-depleting therapies are increasingly being used to treat autoimmune diseases. Although thousands of patients are and have been treated with these agents, the data are not yet strong enough to identify rare side effects with certainty.

Methods: We report the case of a patient undergoing ocrelizumab therapy for relapsing multiple sclerosis who developed a severe limbic syndrome.

Results: Autoimmune pathogenesis was initially suspected, with worsening on immunosuppressive therapy. Later, after diagnosis of an enterovirus infection, treatment with ribavirin and favipiravir in combination with intravenous immunoglobulins was initiated. After 4 weeks of therapy, the patient's clinical condition had stabilized with residual cognitive deficits.

Conclusion: Diagnosis and treatment of enterovirus infections remain challenging, especially in patients receiving immunosuppressive therapy.