RESUMO
BACKGROUND: The acute, fulminant type of Multiple Sclerosis (MS), known as Marburg Disease, has been shown to have poor response to conventional acute treatments typically used for demyelinating diseases. METHODS: We report a 20 y/o postpartum female who was consulted to the Neurology service given findings of subacute left sided hemiparesis, left homonymous hemianopsia and bilateral papilledema. Extensive workup, including Brain and Cervical spine MRI with and without gadolinium, blood work, CSF studies, in addition to her rapid clinical decline, were highly suggestive of the demyelinating variant of Multiple Sclerosis known as Marburg Disease. After excluding other possible diagnosis, she was treated with IV corticosteroids and plasma exchange therapy with poor response. She was then started on monthly high dose cyclophosphamide therapy. RESULTS: Clinical and radiological improvement was present with initiation of cyclophosphamide therapy in this refractory variant of MS. CONCLUSION: Our findings suggest that cyclophosphamide may be a therapeutic alternative to induce clinical and radiological improvement in Marburg Disease.
Assuntos
Ciclofosfamida/uso terapêutico , Imunossupressores/uso terapêutico , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/tratamento farmacológico , Adulto , Encéfalo/patologia , Feminino , Humanos , Esclerose Múltipla/patologia , Troca Plasmática , Resultado do Tratamento , Adulto JovemRESUMO
Cytomegalovirus (CMV) neurologic disease is a serious complication of the acquired immunodeficiency virus (AIDS). We report the case of a 40 year-old woman with AIDS who presented paralysis of lower extremities, areflexia, sensory loss, and urinary retention. CMV polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) allowed confirmation of CMV polyradiculomyelopathy (PRAM).
