Benedetti Luana, Franciotta Diego, Vigo Tiziana, Grandis Marina, Fiorina Elisabetta, Ghiglione Elisabetta, Roccatagliata Luca, Mancardi Giovanni Luigi, Uccelli Antonio, Schenone Angelo
Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Via De Toni 5, 16132 Genova, Italy.
Arch Neurol. 2007 Oct;64(10):1531-3. doi: 10.1001/archneur.64.10.1531.
To describe the unique case of a patient with multiple sclerosis (MS) and anti-myelin-associated glycoprotein (MAG) polyneuropathy who developed MS relapses after treatment with rituximab.
Case report.
Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Genova, Italy. Patient A 59-year-old man with an 18-year history of MS presented with an unusually rapid progression of paraparesis with hypopallesthesia and areflexia in 4 limbs. Neurophysiological and serological studies led to the diagnosis of anti-MAG polyneuropathy. Cerebrospinal fluid analysis disclosed the loss of oligoclonal IgG bands that were previously detected at MS onset. Intervention Rituximab was administered at a dosage of 375 mg/m(2)/wk for 4 weeks. Result The patient developed 2 corticosteroid-responsive MS relapses with improvement of the polyneuropathy.
Rituximab can be effective in anti-MAG polyneuropathy but can possibly lead to unexpected consequences in individuals with MS.
描述一例患有多发性硬化症(MS)和抗髓鞘相关糖蛋白(MAG)多神经病的患者在接受利妥昔单抗治疗后发生MS复发的独特病例。
病例报告。
意大利热那亚大学神经科学、眼科和遗传学系。患者为一名59岁男性,有18年MS病史,出现双下肢轻瘫异常快速进展,伴有四肢感觉减退和反射消失。神经生理学和血清学研究导致抗MAG多神经病的诊断。脑脊液分析显示在MS发病时先前检测到的寡克隆IgG带消失。干预措施:以375mg/m²/周的剂量给予利妥昔单抗,持续4周。结果:患者出现2次对皮质类固醇有反应的MS复发,多神经病有所改善。
利妥昔单抗对抗MAG多神经病可能有效,但在MS患者中可能会导致意想不到的后果。