1. Primary progressive multiple sclerosis to be treated with ocrelizumab: a mistaken case of cobalamin deficiency.
- Author
-
Feldman S, Aljarallah S, and Saidha S
- Subjects
- Aged, Antibodies, Monoclonal, Humanized administration & dosage, Antibodies, Monoclonal, Humanized adverse effects, Cervical Cord diagnostic imaging, Diagnostic Errors, Female, Humans, Immunologic Factors administration & dosage, Immunologic Factors adverse effects, Immunologic Factors therapeutic use, Multiple Sclerosis drug therapy, Vitamin B 12 Deficiency blood, Multiple Sclerosis diagnosis, Vitamin B 12 administration & dosage, Vitamin B 12 Deficiency diagnosis, Vitamin B 12 Deficiency drug therapy, Vitamin B Complex administration & dosage
- Abstract
Cobalamin (vitamin B
12 ) deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders. However, MRI changes associated with cobalamin deficiency are typically spinal predominant and distinct from MS-related changes. We report a case of a patient with cobalamin deficiency who was recommended by her primary neurologist to commence treatment with ocrelizumab, a potent anti-CD20 B-cell depleting monoclonal antibody, after being diagnosed with primary progressive MS. However, cervical spine MRI demonstrated changes classical of cobalamin deficiency including 'inverted V sign' signal hyperintensity and following parenteral cobalamin supplementation her neurological symptoms quickly and dramatically improved., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2019
- Full Text
- View/download PDF