Case Report of Combined Central and Peripheral Demyelination: Treated With Ofatumumab

Combined central and peripheral demyelination (CCPD) is a rare autoimmune-mediated disorder characterized by demyelination affecting both the central nervous system and peripheral nervous system. The involvement of the CNS typically manifests as longitudinally extensive transverse myelitis and optic neuritis, whereas PNS involvement commonly presents as chronic inflammatory demyelinating polyneuropathy (CIDP). Clinically, the course of CCPD can vary from monophasic to relapsing-remitting, leading to complex and diverse symptomatology. There are few studies on the treatment of CCPD. Here we describe two patients diagnosed with CCPD, summarize their clinical features and symptoms, and suggest new approaches to treating CCPD.

We report two young female patients of CCPD with a relapsing-remitting course. Clinically, initial symptoms of limb numbness and weakness responded to treatment but subsequently recurred alongside visual disturbances. Cerebrospinal fluid analysis via lumbar puncture revealed the presence of oligoclonal bands. Nerve conduction studies indicated significantly reduced motor conduction velocities, prolonged distal latencies, conduction block, and extended F-wave latencies across multiple nerves. Brain MRI scans identified multiple long-T2 hyperintense lesions affecting the cortex, subcortical white matter, brainstem, and spinal cord. Acute episodes showed improvement following administration of intravenous immunoglobulin and high-dose methylprednisolone. During remission, treatment with ofatumumab was initiated, and the patients have since remained stable without further relapses.

CCPD is a rare clinical entity that poses a significant challenge for diagnosis and treatment. Our case suggests that Ofatumumab might serve as a potentially effective alternative for CCPD patients.