Catastrophic relapses following initiation of dimethyl fumarate in two patients with neuromyelitis optica spectrum disorder
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
SAGE Publications Ltd
Abstract
We report two cases of neuromyelitis optica spectrum disorder (NMOSD) who were misdiagnosed as multiple sclerosis (MS) and developed catastrophic relapses following initiation of dimethyl fumarate. Both patients developed a severe myelitis extending from the cervical cord to the medulla with significant cord swelling, resulting in complete quadriplegia and respiratory difficulties, in addition to severe bilateral visual loss in one patient. It is of note that both catastrophic relapses occurred 2 and 3 months following initiation of dimethyl fumarate. © 2017, © The Author(s), 2017.
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Keywords
Aquaporin 4, Dimethyl fumarate, Neuromyelitis optica, Adult, Blindness, Diagnostic errors, Fatal outcome, Female, Humans, Immunosuppressive agents, Middle aged, Multiple sclerosis, Myelitis, Quadriplegia, Recurrence, Azathioprine, Beta interferon, Corticotropin, Fumaric acid dimethyl ester, Lymphocyte antibody, Lymphocyte antigen, Methylprednisolone, Prednisone, Immunosuppressive agent, Aquaporin 4 antibody, Beta1a interferon, Article, Blurred vision, Brain stem injury, Case report, Cerebrospinal fluid examination, Cervical myelopathy, Cervical spinal cord, Cervical spinal cord injury, Diagnostic error, Disease exacerbation, Disease severity, Drug megadose, Drug substitution, Drug withdrawal, Dysesthesia, Human, Immunofluorescence test, Lumbar puncture, Lymphocyte count, Medulla oblongata, Muscle weakness, Myelooptic neuropathy, Neuroimaging, Nuclear magnetic resonance imaging, Optic chiasm, Optic nerve disease, Plasmapheresis, Relapse, Respiratory failure, Spinal cord disease, Terminal disease, Vertigo, Visual evoked potential, Visual impairment, White matter lesion, Chemically induced, Fatality, Recurrent disease, Antibody blood level, Brain edema, Clinical article, Cord swelling, Indirect immunofluorescence assay, Lebanese, Limb weakness, Respiratory arrest, Respiratory distress, Swelling, Syrian, Treatment refusal