title: Management of Fulminant Multiple Sclerosis With Rituximab: A Case Report.
abstract: BACKGROUND
  Malignant variant is a rare subtype of multiple sclerosis (MS) that is rapidly progressive and may lead to significant disability or even death. No consensus exists on best management of this disorder, although corticosteroids and plasmapheresis are commonly used in the acute phase, followed either by MS-specific disease-modifying therapy or an immunosuppressant.
  
  
  METHODS
  The patient is a 30-year-old man with relapsing-remitting MS previously well controlled with natalizumab, who has developed fulminant disease activity upon natalizumab cessation. In the acute phase, patient had a suboptimal response to multiple corticosteroid treatments but responded very well to plasmapheresis. Patient continued to have worsening disease activity despite fingolimod treatment. Disease control has been eventually achieved by switching to rituximab.
  
  
  CONCLUSIONS
  Rituximab treatment should be considered for a patient with fulminant MS who responded well to plasmapheresis.
authors.affiliation: Department of Neurology, Division of Neuroimmunology, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Valeriy
authors.initials: V
authors.lastname: Parfenov
authors.forename: Renaud
authors.initials: R
authors.lastname: Du Pasquier
authors.forename: Myriam
authors.initials: M
authors.lastname: Schluep
mesh_terms: D000328:Adult; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use; D010956:Plasmapheresis; D000069283:Rituximab / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab; D000069283:Rituximab