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Luana Benedetti, MD; Diego Franciotta, MD; Tiziana Vigo, PhD; Marina Grandis, MD; Elisabetta Fiorina, MD; Elisabetta Ghiglione, MD; Luca Roccatagliata, PhD; Giovanni Luigi Mancardi, MD; Antonio Uccelli, MD; Angelo Schenone, MD

Arch Neurol. 2007;64(10):1531-1533.

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.

Design  Case report.

Setting  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/m²/wk for 4 weeks.

Result  The patient developed 2 corticosteroid-responsive MS relapses with improvement of the polyneuropathy.

Conclusion  Rituximab can be effective in anti-MAG polyneuropathy but can possibly lead to unexpected consequences in individuals with MS.

Author Affiliations: Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Genova, Italy (Drs Benedetti, Vigo, Grandis, Fiorina, Ghiglione, Roccatagliata, Mancardi, Uccelli, and Schenone), and Laboratory of Neuroimmunology, IRCCS, Neurological Institute C. Mondino, University of Pavia, Pavia, Italy (Dr Franciotta).

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