Plasma Exchange in a Patient with Tumefactive, Corticosteroid-Resistant Multiple Sclerosis

Area of Science:

• Neurology
• Immunology

Background:

• Tumefactive multiple sclerosis (MS) is an aggressive subtype often resistant to standard treatments.
• Plasma exchange (PLEX) is used for severe MS relapses, but its efficacy in tumefactive MS is not well-documented.

Purpose of the Study:

• To report the successful use of plasma exchange (PLEX) as a second-line treatment for a patient with tumefactive multiple sclerosis (MS).

Main Methods:

• A patient with tumefactive MS presenting with severe symptoms unresponsive to intravenous methylprednisolone was treated with plasma exchange (PLEX).
• Disease-modifying therapy with natalizumab was initiated post-PLEX.

Main Results:

• The patient showed significant clinical improvement after the second PLEX session, enabling discharge.
• While natalizumab prevented further relapses, a slow clinical decline occurred over the subsequent year, leading to treatment discontinuation.

Conclusions:

• Plasma exchange (PLEX) can be an effective second-line therapy for corticosteroid-resistant tumefactive MS relapses.
• Despite initial PLEX success, long-term disease management in aggressive tumefactive MS remains challenging.