Relapses after treatment with rituximab in a patient with multiple sclerosis and anti-myelin-associated glycoprotein polyneuropathy
Relapses after treatment with rituximab in a patient with multiple sclerosis and anti-myelin-associated glycoprotein polyneuropathy
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DOI：
10.1001/archneur.64.10.1531
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发表时间：
2007-10-01
影响因子：
--
通讯作者：
Schenone, Angelo
中科院分区：
文献类型：
--
作者：
Benedetti, Luana;Franciotta, Diego;Schenone, Angelo
目的：描述一例多发性硬化（MS）和抗髓鞘相关糖蛋白（MAG）多发性神经病患者，在利妥昔单抗治疗后MS复发。设计：病例报告。设置：热那亚大学神经科学、眼科和遗传学系，热那亚，意大利。患者：一名有18年MS病史的59岁男性出现异常快速进展的下肢轻瘫伴感觉减退和四肢无反射。神经生理学和血清学研究导致抗MAG多发性神经病的诊断。脑脊液分析显示MS发病时检测到的寡克隆IgG条带丢失。干预措施：利妥昔单抗以375 mg/m2/wk的剂量给药4 wk。结果：患者出现2次皮质类固醇反应性MS复发，多发性神经病改善。结论：利妥昔单抗可有效抗MAG多发性神经病，但可能导致MS患者出现意想不到的后果。
Objective: 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.Design: Case report.Setting: 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.Conclusion: Rituximab can be effective in anti-MAG polyneuropathy but can possibly lead to unexpected consequences in individuals with MS.