Highlights
- •Description of a typical case of MS overlapping with NMOSD.
- •Humoral immunity as appropriate target for MS and NMOSD overlapping disorders.
- •B cell depleting agents may be preferred for challenging demyelinating cases.
Abstract
Multiple sclerosis and neuromyelitis optica spectrum disorder are currently thought
to be independent entities. Some patients display intermediate manifestations that
fit the criteria for both diseases without positive relevant serobiomarkers. An overall
standard and consensus for the diagnosis and treatment of these overlapping patients
have not been reached. We describe a patient with frequently relapsing demyelinating
episodes and repeatedly adjusted treatment regimens due to diagnostic difficulties.
This case did not respond adequately to glucocorticoid plus azathioprine or to interferon.
Benefits were finally obtained by using rituximab, an anti-CD20 specific monoclonal
antibody targeting B cells. Treatments targeting B cell mediated humoral immunity
such as rituximab, may be a safe and appropriate choice for these challenging demyelinating
cases, especially in Asian population.
Keywords
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References
- Rituximab in the treatment of Neuromyelitis optica: a multicentre Italian observational study.J. Neurol. 2016; 263: 1727-1735
- MRI criteria for the diagnosis of multiple sclerosis: magnims consensus guidelines.Lancet Neurol. 2016; 15: 292-303
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Article info
Publication history
Published online: March 26, 2018
Accepted:
March 23,
2018
Received in revised form:
January 23,
2018
Received:
November 6,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
