ABSTRACT
Background Management of patients with multiple sclerosis (MS) and evidence of disease activity during treatment with cladribine tablets represents a challenging point. Objectives To report a patient with highly active multiple sclerosis (HAMS) who has been early switched from cladribine to alemtuzumab owing to tumultuous clinical and radiological activity Methods A single retrospective case report. Results. Treatment with alemtuzumab has led to a complete suppression of disease activity without any evidence of infections or acquired autoimmune diseases. Conclusion Our report suggests that an early switch from cladribine to alemtuzumab, may be safe and efficacious in selected HAMS cases.Copyright © 2022 The Authors
ABSTRACT
Background: Acute zonal occult outer retinopathy (AZOOR) is a rare, recently introduced sectorial outer retinopathy commonly seen in young females. The presence of AZOOR in multiple sclerosis (MS) patients can sometimes masquerade as optic neuritis. We hereby analyze an infrequent case of such an incident, as well as the comorbidities of this particular patient and the arising differential diagnostic dilemmas. Case Presentation: A 29-year-old female MS patient on cladribine presented in the emergency department (ED) due to left eye (LE) visual disturbances which appeared after Covid-19 infection. As a result of her past medical history, the case was considered to be consistent with optic neuritis. The patient was treated with high doses of intravenous methylprednisolone, but despite the treatment symptoms persisted. Ophthalmological findings were compatible with AZOOR. Conclusion(s): AZOOR can coexist with MS. However, it is unclear whether cladribine treatment or Covid-19 infection triggered AZOOR. Given the potential for ocular adverse effects associated with cladribine use, patients should be encouraged to report visual disturbances promptly. In addition, medical professionals must be vigilant of MS patients on cladribine complaining of visual symptoms, and refer them to an ophthalmologist as soon as possible.Copyright © 2022 The Author(s)