title: Favourable response to plasma exchange in tumefactive CNS demyelination with delayed B-cell response.
abstract: We report a case of multiple sclerosis-associated fulminant tumefactive demyelinating lesion (TDL) with the special feature of delayed humoral immune response. Plasma exchange (PE) yielded significant benefit in two consecutive steroid-unresponsive relapses, while signs of an intrathecal B-cell response were only present 2 years later at the second relapse. Remission was achieved and sustained thereafter with natalizumab. Our case indicates that PE might be a therapeutic option even when the B-cell response is not fully developed. This delay in the development of a humoral immune response may reflect the step-wise B-cell colonization of the CNS and represent an attractive therapeutic window of opportunity.
authors.affiliation: Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Seifert
authors.forename: Christiane
authors.initials: C
authors.lastname: Wegner
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
authors.forename: Martin S
authors.initials: MS
authors.lastname: Weber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brück
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hemmer
authors.forename: Johann
authors.initials: J
authors.lastname: Sellner
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology; D001921:Brain / Q000473:pathology*; D003711:Demyelinating Diseases / Q000209:etiology / Q000276:immunology / Q000628:therapy; D018450:Disease Progression; D005434:Flow Cytometry; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000276:immunology* / Q000473:pathology* / Q000628:therapy; D000069442:Natalizumab; D010951:Plasma Exchange; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab