Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient
Multiple sclerosis (MS) is a relapse remitting immune-mediated demyelinating neurological disorder that primarily affects women of childbearing age. In most patients, the hormonal changes during pregnancy are protective against MS relapses. When relapses do occur, treatment options are limited to us...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2020/4536145 |
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| author | Lindsey Dalka Antoine Harb Kael Mikesell Gillian Gordon Perue |
| author_facet | Lindsey Dalka Antoine Harb Kael Mikesell Gillian Gordon Perue |
| author_sort | Lindsey Dalka |
| collection | DOAJ |
| description | Multiple sclerosis (MS) is a relapse remitting immune-mediated demyelinating neurological disorder that primarily affects women of childbearing age. In most patients, the hormonal changes during pregnancy are protective against MS relapses. When relapses do occur, treatment options are limited to use of intravenous steroids and plasmapheresis rescue therapy. We present a case of steroid refractory MS-transverse myelitis with quadriplegia in a 25-year-old pregnant super morbidly obese woman. Our clinical case is unique because the severity of her relapse early in pregnancy, which was intractable and resistant to steroids. This may have been a rebound demyelination due to the discontinuation of fingolimod; a newly recognized entity by the FDA. Our case report therefore seeks to raise awareness about a potential complication of discontinuing MS disease modifying therapies, highlighting that these rebound relapses can be steroid resistant and occur despite the usual protective hormonal influence of early pregnancy and that plasma exchange is a valid treatment option. Finally, we discuss the challenges of determining exchange volumes for plasmapheresis in the super morbid obese population to secure good maternal and fetal outcomes. |
| format | Article |
| id | doaj-art-90fb92f4e5224551ba6f51909ed63ea6 |
| institution | DOAJ |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-90fb92f4e5224551ba6f51909ed63ea62025-08-20T03:20:32ZengWileyCase Reports in Neurological Medicine2090-66682090-66762020-01-01202010.1155/2020/45361454536145Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant PatientLindsey Dalka0Antoine Harb1Kael Mikesell2Gillian Gordon Perue3Eastern Maine Medical Center, Department of Family Medicine, Bangor, USAEastern Maine Medical Center, Department of Hematology and Oncology, Bangor, USAEastern Maine Medical Center, Department of Patient Blood Management, Bangor, USAEastern Maine Medical Center, Department of Neurology, Bangor, USAMultiple sclerosis (MS) is a relapse remitting immune-mediated demyelinating neurological disorder that primarily affects women of childbearing age. In most patients, the hormonal changes during pregnancy are protective against MS relapses. When relapses do occur, treatment options are limited to use of intravenous steroids and plasmapheresis rescue therapy. We present a case of steroid refractory MS-transverse myelitis with quadriplegia in a 25-year-old pregnant super morbidly obese woman. Our clinical case is unique because the severity of her relapse early in pregnancy, which was intractable and resistant to steroids. This may have been a rebound demyelination due to the discontinuation of fingolimod; a newly recognized entity by the FDA. Our case report therefore seeks to raise awareness about a potential complication of discontinuing MS disease modifying therapies, highlighting that these rebound relapses can be steroid resistant and occur despite the usual protective hormonal influence of early pregnancy and that plasma exchange is a valid treatment option. Finally, we discuss the challenges of determining exchange volumes for plasmapheresis in the super morbid obese population to secure good maternal and fetal outcomes.http://dx.doi.org/10.1155/2020/4536145 |
| spellingShingle | Lindsey Dalka Antoine Harb Kael Mikesell Gillian Gordon Perue Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient Case Reports in Neurological Medicine |
| title | Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient |
| title_full | Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient |
| title_fullStr | Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient |
| title_full_unstemmed | Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient |
| title_short | Medically Refractory Multiple Sclerosis Is Successfully Treated with Plasmapheresis in a Super Morbidly Obese Pregnant Patient |
| title_sort | medically refractory multiple sclerosis is successfully treated with plasmapheresis in a super morbidly obese pregnant patient |
| url | http://dx.doi.org/10.1155/2020/4536145 |
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