Neuromyelitis optica presenting with relapses under treatment with natalizumab: a case report

Journal of Medical Case Reports

Ralf Andreas Linker²  Stefan Schwab²  Christian Maihöfner²  Tobias Struffert¹  Anne Waschbisch²  Alexandra B Laemmer²  De-Hyung Lee² 

[1] Department of Neuroradiology, Friedrich-Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany;Department of Neurology, Friedrich-Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany

关键词: Seroconversion;    Anti-AQP-4 antibodies;    Rituxan;    Multiple sclerosis;    Natalizumab;    Neuromyelitis optica;   

Others  :  820935
DOI  :  10.1186/1752-1947-8-155

 received in 2013-12-30, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Introduction

Neuromyelitis optica is an inflammatory demyelinating disease of the central nervous system. To date, optimal therapeutic approaches for neuromyelitis optica have yet to be defined. Natalizumab is highly effective in relapsing-remitting multiple sclerosis and might be considered as an option.

Case presentation

Here, we describe a 67-year-old Caucasian man with definite neuromyelitis optica with detection of anti-aquaporin-4 antibodies over the course of the disease. After initially discussing the diagnosis of multiple sclerosis at an outside hospital, our patient received interferon beta 1a as well as repeated corticosteroid pulses without success. Under subsequent therapy with natalizumab, he continued to present relapses. It was not until discontinuation of natalizumab, repeated cycles of plasma exchanges and initiation of therapy with rituxan that the disease course started to stabilize. Although B cells were completely depleted, our patient experienced another severe myelitis relapse during further follow-up and an additional immunosuppressive therapy with cyclophosphamide was started. Under this regimen, no further relapses occurred over the next 24 months.

Conclusions

This case adds further evidence to the previously discussed notion that natalizumab, while highly effective in multiple sclerosis, may not work sufficiently in neuromyelitis optica. It further advocates for repetitive testing of anti-aquaporin-4 antibodies before and after treatment initiation.

【 授权许可】

   
2014 Lee et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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