AUTHOR=Breitkopf Katharina , Aytulun Aykut , Förster Moritz , Kraus Bastian , Turowski Bernd , Huppert Doreen , Goebels Norbert , Hefter Harald , Aktas Orhan , Metz Imke , Brück Wolfgang , Reifenberger Guido , Hartung Hans-Peter , Albrecht Philipp 

TITLE=Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00782

DOI=10.3389/fneur.2020.00782

ISSN=1664-2295

ABSTRACT=Tumefactive multiple sclerosis is a rare variant of multiple sclerosis (MS) that may lead to a rapidly progressive clinical deterioration requiring a multidisciplinary diagnostic work up. Our report describes the diagnostic and therapeutic approach of a rare and extremely severe course of MS.
A 51-year-old man with an 8-year history of relapsing-remitting multiple sclerosis (RRMS) was admitted with a subacute progressive left lower limb weakness and deterioration of walking ability. After extensive investigations including repeated MRI, microbiological, serological, CSF studies and finally brain biopsy the diagnosis of a tumefactive MS lesion was confirmed. Despite repeated IV steroids as well as plasma exchanges and IV foscarnet and ganciclovir due to low copy numbers of HHV-6 DNA in PCR analysis the patient did not recover. 
The clinical presentation of tumefactive MS is rare and variable. Brain biopsy for histopathological work-up should be considered in immunocompromised patients with rapidly progressive clinical deterioration with brain lesions of uncertain cause.