Primary progressive multiple sclerosis to be treated with ocrelizumab: a mistaken case of cobalamin deficiency.

• 发表时间: May 2019 14
• 来源期刊: BMJ Case Rep
• DOI: 10.1136/bcr-2018-229080
• PMID: 31092497
• 文章类型: Case Reports
• 作者列表: Feldman S,Aljarallah S,Saidha S

关键词: multiple sclerosis; vitamins and supplements

Mesh: Aged; Antibodies, Monoclonal, Humanized / administration & dosage adverse effects; Cervical Cord / diagnostic imaging; Diagnostic Errors; Female; Humans; Immunologic Factors / administration & dosage adverse effects therapeutic use; Multiple Sclerosis / diagnosis drug therapy; Vitamin B 12 / administration & dosage; Vitamin B 12 Deficiency / blood diagnosis drug therapy; Vitamin B Complex / administration & dosage

Abstract

Cobalamin (vitamin B12) deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders. However, MRI changes associated with cobalamin deficiency are typically spinal predominant and distinct from MS-related changes. We report a case of a patient with cobalamin deficiency who was recommended by her primary neurologist to commence treatment with ocrelizumab, a potent anti-CD20 B-cell depleting monoclonal antibody, after being diagnosed with primary progressive MS. However, cervical spine MRI demonstrated changes classical of cobalamin deficiency including \'inverted V sign\' signal hyperintensity and following parenteral cobalamin supplementation her neurological symptoms quickly and dramatically improved.