AUTHOR=Koska Valeria , Förster Moritz , Brouzou Katja , Hatami Maryam , Arat Ercan , Aytulun Ahmet , Albrecht Philipp , Aktas Orhan , Küry Patrick , Meuth Sven G. , Kremer David 

TITLE=Case Report: Successful Stabilization of Marburg Variant Multiple Sclerosis With Ocrelizumab Following High-Dose Cyclophosphamide Rescue

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.696807

DOI=10.3389/fneur.2021.696807

ISSN=1664-2295

ABSTRACT=The Marburg variant of multiple sclerosis (Marburg MS) is the most aggressive form of MS often leading to death soon after onset. Here, we describe the case of a 26-year-old Marburg MS patient presenting with severe neurological deficits requiring intensive care. In spite of more than 100 Gadolinium-enhancing MRI lesions the patient recovered almost completely upon high dose cyclophosphamide (HiCy) rescue treatment (four consecutive days with 50 mg/kg/day, cumulative absolute dose of 14 g). Following acute treatment her disease was stabilized by B cell depletion using ocrelizumab. Clinical amelioration was reflected by a decrease of MRI activity and a marked decline of serum neurofilament light chain (NfL) levels. HiCy rescue treatment followed by ocrelizumab as a maintenance therapy prevents permanent disability and achieves an almost complete clinical and drastic radiological improvement in this Marburg MS patient.