Mild COVID-19 symptoms despite treatment with teriflunomide and high-dose methylprednisolone due to multiple sclerosis r
- PDF / 696,417 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 56 Downloads / 133 Views
LETTER TO THE EDITORS
Mild COVID‑19 symptoms despite treatment with teriflunomide and high‑dose methylprednisolone due to multiple sclerosis relapse Nora Möhn1 · Firas Saker1 · Viktoria Bonda1 · Gesine Respondek1 · Marcus Bachmann2 · Matthias Stoll2 · Mike P. Wattjes3 · Martin Stangel1 · Thomas Skripuletz1 Received: 29 April 2020 / Revised: 13 May 2020 / Accepted: 14 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, The current SARS-CoV-2 pandemic is a huge challenge for health systems around the world. Several risk factors for a severe course of the coronavirus disease (COVID-19) have been identified including advanced age, previous cardiovascular diseases such as diabetes and high blood pressure, male sex, and obesity [1, 2]. Since sufficient data are still lacking, it has not yet been possible to clarify whether patients under immunomodulatory therapy are at greater risk [3]. It has been suggested that children and adults with immunosuppression may have a rather favourable disease course compared to the general population [4]. A high-dose steroid treatment generally carries a higher risk of infection [5, 6]. Hitherto, there is no evidence that coronavirusinfected patients (both in previous outbreaks and currently) with simultaneous steroid therapy have a more severe course of disease [3, 7]. In the following, we describe the case of a multiple sclerosis (MS) patient who suffered from an undiagnosed SARS-CoV-2 infection and received high-dose methylprednisolone therapy in the assumption of an MS relapse. We show here that the COVID-19 course in this patient was mild and well controllable despite the additional immunosuppressive treatment. A 42-year old male patient who had been diagnosed with relapsing-remitting MS in 2013 according to the 2010 revisions of the McDonald criteria [8] presented at the emergency room of our clinic in April 2020 due to gait * Thomas Skripuletz skripuletz.thomas@MH‑Hannover.de 1
Department of Neurology, Hannover Medical School, Hannover, Germany
2
Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
3
Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
disturbance which occurred 2 weeks before. Since the initial diagnosis, the MS was sufficiently controlled with teriflunomide. No relapse had occurred so far. He had been clinically asymptomatic, and the annual imaging follow-ups (last in 2019) had not shown inflammatory disease activity. The patient was otherwise healthy. In the context of the current neurological presentation, a mild gait ataxia and hypermetric finger chase test were noticeable. In addition, the patient reported nausea and vomiting, a general weakness and sore throat. Fever or cough had not been noticed. Laboratory analysis showed slightly increased inflammation parameter (Fig. 1a,b). Both, chest X-ray and urine analysis remained unremarkable. The brain MRI showed a new T2 lesion within the right cerebellum (Fig. 1d, previous MRI was per
Data Loading...
