Relapses after treatment with rituximab in a patient with multiple sclerosis and anti myelin-associated glycoprotein polyneuropathy.
OBJECTIVE
To describe the unique case of a patient with multiple sclerosis (MS) and anti-myelin-associated glycoprotein (MAG) polyneuropathy who developed MS relapses after treatment with rituximab.


METHODS
Case report.


METHODS
Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Genova, Italy. Patient A 59-year-old man with an 18-year history of MS presented with an unusually rapid progression of paraparesis with hypopallesthesia and areflexia in 4 limbs. Neurophysiological and serological studies led to the diagnosis of anti-MAG polyneuropathy. Cerebrospinal fluid analysis disclosed the loss of oligoclonal IgG bands that were previously detected at MS onset. Intervention Rituximab was administered at a dosage of 375 mg/m(2)/wk for 4 weeks. Result The patient developed 2 corticosteroid-responsive MS relapses with improvement of the polyneuropathy.


CONCLUSIONS
Rituximab can be effective in anti-MAG polyneuropathy but can possibly lead to unexpected consequences in individuals with MS.
Benedetti
Luana
L
Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Via De Toni 5, 16132 Genova, Italy. luanabenedetti@libero.it
Franciotta
Diego
D
Vigo
Tiziana
T
Grandis
Marina
M
Fiorina
Elisabetta
E
Ghiglione
Elisabetta
E
Roccatagliata
Luca
L
Mancardi
Giovanni Luigi
GL
Uccelli
Antonio
A
Schenone
Angelo
A
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies / Q000134:cerebrospinal fluid; D020274:Autoimmune Diseases of the Nervous System / Q000150:complications / Q000188:drug therapy*; D004594:Electrophysiology; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D007525:Isoelectric Focusing; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D018992:Myelin-Associated Glycoprotein / Q000276:immunology*; D009460:Neurologic Examination; D011115:Polyneuropathies / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D018992:Myelin-Associated Glycoprotein; D000069283:Rituximab