Treatment of Marburg variant multiple sclerosis with mitoxantrone

Marburg variant multiple sclerosis (MS) is a severe, sometimes monophasic, form of MS leading to advanced disability or death within a period of weeks to months. No consistently successful treatment for Marburg variant MS has been described. The case reported here is that of a 34-year-old woman with Marburg variant MS whose magnetic resonance imaging scan showed extensive brainstem, periventricular white matter, subcortical, and cortical involvement, giving the appearance of an "MS cerebritis." The patient had no response to treatment with methylprednisolone but improved and recovered after treatment with mitoxantrone (MITX). Because MITX has potent anti-inflammatory effects and demonstrated efficacy in worsening MS, it may be an appropriate agent for the treatment of Marburg variant MS.