title: Catastrophic relapses following initiation of dimethyl fumarate in two patients with neuromyelitis optica spectrum disorder.
abstract: We report two cases of neuromyelitis optica spectrum disorder (NMOSD) who were misdiagnosed as multiple sclerosis (MS) and developed catastrophic relapses following initiation of dimethyl fumarate. Both patients developed a severe myelitis extending from the cervical cord to the medulla with significant cord swelling, resulting in complete quadriplegia and respiratory difficulties, in addition to severe bilateral visual loss in one patient. It is of note that both catastrophic relapses occurred 2 and 3 months following initiation of dimethyl fumarate.
authors.affiliation: Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Yamout
authors.affiliation: Ain Wazein Hospital, El Chouf, Lebanon.
authors.forename: Shawkat
authors.initials: S
authors.lastname: Beaini
authors.affiliation: Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Maya M
authors.initials: MM
authors.lastname: Zeineddine
authors.affiliation: Hammoud Hospital University Medical Center, Saida, Lebanon.
authors.forename: Nabil
authors.initials: N
authors.lastname: Akkawi
mesh_terms: D000328:Adult; D001766:Blindness / Q000139:chemically induced*; D003951:Diagnostic Errors; D000069462:Dimethyl Fumarate / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy; D009187:Myelitis / Q000139:chemically induced*; D009471:Neuromyelitis Optica / Q000175:diagnosis* / Q000188:drug therapy*; D011782:Quadriplegia / Q000139:chemically induced*; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents; D000069462:Dimethyl Fumarate
keywords: Neuromyelitis optica; aquaporin 4; dimethyl fumarate