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 (MS) is a rare variant of MS that may lead to a rapidly progressive clinical deterioration requiring a multidisciplinary diagnostic workup. 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 MS (RRMS) was admitted with a subacute progressive left lower limb weakness and deterioration of walking ability. After extensive investigations including repeated MRI, microbiological, serological, cerebrospinal fluid (CSF) studies, and finally brain biopsy, the diagnosis of a tumefactive MS lesion was confirmed. Despite repeated intravenous (IV) steroids as well as plasma exchanges and IV foscarnet and ganciclovir owing to low copy numbers of human herpesvirus 6 (HHV-6) DNA in polymerase chain reaction (PCR) analysis, the patient did not recover. The clinical presentation of tumefactive MS is rare and variable. Brain biopsy for histopathological workup should be considered in immunocompromised patients with rapidly progressive clinical deterioration with brain lesions of uncertain cause.