Cyclophosphamide/immune-globulin/methylprednisolone

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Cyclophosphamide/immune-globulin/methylprednisolone

Lack of efficacy during treatment myelin oligodendrocyte glycoprotein antibodies-related disease: case report A 43-year-old woman exhibited lack of efficacy during treatment with methylprednisolone, immune globulin and cyclophosphamide for myelin oligodendrocyte glycoprotein antibodies (MOG-IgG)-related disease [not all dosages and routes stated]. The woman was admitted in February 2018 with progressive bilateral visual acuity loss followed by convulsive seizure. MRI revealed multifocal white matter lesions like acute disseminated encephalomyelitis. Subsequently, she was diagnosed with MOG‐IgG‐related disorders. She was then treated with IV immune globulin [immunoglobulin] therapy 0.4 mg/kg for 5 days along with 3 courses of plasma exchange, and high‐dose methylprednisolone. But, her condition remained refractory to all these treatments. After 5 months from the onset, brain biopsy was performed, which revealed extensive demyelinated lesions with infiltrations of macrophages and partial CD8+ T-cells. Given the continuous activity of cellular immunity, her treatment was switched to high‐dose cyclophosphamide 500 mg/month, which was continued for 4 months. Despite the treatment, her brain lesions were found to be enlarged. Flow cytometry analysis showed increased numbers of B‐cell subsets related to the auto-antibody production. Thereafter, the woman was treated with rituximab. A subsequent improvement was seen, and the lesions also found to be reduced. Matsumoto Y, et al. A case of refractory MOG-IgG-related disorder treated with rituximab. Clinical and Experimental Neuroimmunology 11 (Suppl. 1): 61 (plus oral presentation) abstr. P-4, Mar 2020. Available from: URL: http://doi.org/10.1111/cen3.12572 [abstract]

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Reactions 22 Aug 2020 No. 1818

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