Open AccessOnset of secondary progressive MS after long‐term rituximab therapy – a case report
Author(s) -
Büdingen H.Christian,
Bischof Antje,
Eggers Erica L.,
Wang Shengzhi,
Bevan Carolyn J.,
Cree Bruce A. C.,
Henry Roland G.,
Hauser Stephen L.
Publication year - 2017
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.377
Subject(s) - medicine , rituximab , multiple sclerosis , cerebrospinal fluid , spinal cord , white matter , pathology , oncology , immunology , lymphoma , radiology , magnetic resonance imaging , psychiatry
A patient with relapsing multiple sclerosis ( RMS ) was treated with a standard immunomodulatory therapy, but due to ongoing disease activity was switched to rituximab. Relapses ceased, but secondary progressive MS ( SPMS ) eventually appeared, associated with new focal spinal cord white matter lesions. Cerebrospinal fluid ( CSF ) showed persistent oligoclonal bands ( OCB ) and clonally related B cells in CSF and peripheral blood. The treatment escalation approach failed to prevent evolution to SPMS , raising the question of whether initiation of B‐cell depleting therapy at the time of RMS diagnosis should be tested to more effectively address the immune pathology leading to SPMS .