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Case reports in neurology
Door Kale A en Tepe N.
Inhoud in het Engels
Rebound after teriflunomide discontinuation is uncommon and difficult to distinguish from ordinary disease reactivation without a documented pretreatment baseline. Tumefactive demyelination is a rarely reported post-cessation phenotype.
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This report presents a 39-year-old woman with relapsing-remitting multiple sclerosis had no relapses, Expanded Disability Status Scale (EDSS) worsening, or new MRI lesions during approximately 5 years of teriflunomide treatment. She stopped treatment without medical supervision or an accelerated elimination procedure for pregnancy planning. Four months later, persistent headache prompted MRI, which showed a 2.6 × 2.6-cm right frontal periventricular tumefactive demyelinating lesion with edema, peripheral diffusion restriction, and mild ring enhancement, plus a new left cerebellar plaque. EDSS remained 0. Absolute lymphocyte count rose from 600 cells/μL at the last on-treatment visit to 1,700 cells/μL at presentation. Serum MOG-IgG and AQP4-IgG and CSF cytology were negative; a type 2 oligoclonal-band pattern was present, and targeted infectious screening showed no evidence of active infection. Teriflunomide concentration was <0.02 mg/L twice, 14 days apart. Intravenous methylprednisolone (1 g/day for 5 days) resolved the headache. Cladribine was then started, and 1-month MRI showed marked regression. EDSS remained 0 and no new or enhancing lesion appeared through 12 months.
The tumor-like lesion exceeded the patient's pretreatment radiological phenotype, but the absence of objective deficit, EDSS worsening, and a high lesion burden makes definitive rebound uncertain. Rebound-like post-cessation inflammatory activity is the most defensible description. Supervised treatment transition and clinical and MRI monitoring are important when teriflunomide is stopped.
Gepubliceerd in Case reports in neurology. Het abstract staat hier zoals het is gepubliceerd en blijft het werk van de auteurs; lees het volledige artikel bij de bron.
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