PMU-Autor/inn/en
Sellner JohannAbstract
We report a case of multiple sclerosis-associated fulminant tumefactive demyelinating lesion (TDL) with the special feature of delayed humoral immune response. Plasma exchange (PE) yielded significant benefit in two consecutive steroid-unresponsive relapses, while signs of an intrathecal B-cell response were only present 2 years later at the second relapse. Remission was achieved and sustained thereafter with natalizumab. Our case indicates that PE might be a therapeutic option even when the B-cell response is not fully developed. This delay in the development of a humoral immune response may reflect the step-wise B-cell colonization of the CNS and represent an attractive therapeutic window of opportunity.
Useful keywords (using NLM MeSH Indexing)
Adult
Antibodies, Monoclonal, Humanized/therapeutic use
B-Lymphocytes/immunology
Brain/pathology*
Demyelinating Diseases/etiology
Demyelinating Diseases/immunology
Demyelinating Diseases/therapy
Disease Progression
Flow Cytometry
Humans
Magnetic Resonance Imaging
Male
Multiple Sclerosis/complications*
Multiple Sclerosis/immunology*
Multiple Sclerosis/pathology*
Multiple Sclerosis/therapy
Plasma Exchange*
T-Lymphocytes/immunology
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humoral immune response