At the Consortium of Multiple Sclerosis Centers (CMSC) 38th Annual Meeting, researchers presented a case study of a 53-year-old woman who was misdiagnosed with multiple sclerosis (MS) and experienced adverse effects due to receiving the immunotherapy intrave­nous immunoglobulin (IVIG).

The patient sought out a second opinion for MS treatment at the researchers’ immunology clinic. She was initially diagnosed with MS in 2015. Her initial symptoms consisted of cognitive issues, vision problems, leg spasms, unsteady gait, and paresthesia. Her brain MRI scan showed scattered, small T2 hyperintensities in subcortical white matter without corresponding T1 hypointensities or enhancement. The MRI orbit did not show anything unusual, and a spine MRI was not performed. She also completed a lumbar puncture, which confirmed an elevated opening pressure. However, no other results from this exam were available.

After her initial diagnosis, she received glatiramer acetate and dimethyl fumarate to manage the disease. In 2016, she switched to receiving IVIG infusions on a bimonthly basis. However, the IVIG treatment caused her to have severe headaches and nausea that lasted for more than a week after each infusion. Furthermore, her neurologic exam results were nor­mal, except for mild disc edema on the right side of the brain.

The researchers could not confirm a diagnosis of MS because there was a lack of historical evidence of a typical demyelinating event and nonspecific white matter lesions. They had the patient discontinue IVIG treatments due to the severe adverse effects.

The case study highlighted the importance of fulfilling the McDonald criteria when determining diagnosis of MS to prevent misdiagnosis and unnecessary treatment, according to the authors. They note that IVIG is a “controversial” treatment option compared to other “multiple effective and safe medications approved for disease modification in MS.”

Reference

Duque Ramirez A, Nguyen D, Reyna T. Double trouble? Intravenous immunoglobulin in a case of multiple sclerosis misdiagnosis. Presented at: CMSC 2024; May 29-June 1, 2024; Nashville, TN; Abstract CS02.