- •Severe CNS inflammation after discontinuation of natalizumab and start of daclizumab.
- •Alemtuzumab was able to stabilize a devastating disease course.
- •Alemtuzumab represents a powerful drug after the use of daclizumab in patients with highly active multiple sclerosis.
Natalizumab is highly effective in the treatment of relapsing multiple sclerosis patients. Unfortunately, after stopping natalizumab, there is an increased risk of inflammation in the central nervous system and relapses. Switching from natalizumab to an alternative sufficient drug may prevent disease reactivation. Here we present a case of a patient who experienced a dramatic course with severe central nervous system inflammation after discontinuation of natalizumab and treatment initiation with daclizumab. During a treatment of 36 days, 20 g intravenous methylprednisolone in total and ten courses of plasmapheresis were not able to control the severe CNS inflammation. Alemtuzumab, which targets the whole lymphocyte population, was able to stabilize the devastating disease course in our case.
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Published online: March 29, 2018
Accepted: March 28, 2018
Received in revised form: March 20, 2018
Received: September 20, 2017
© 2018 Elsevier B.V. All rights reserved.