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BMJ Case Reports 2014; doi:10.1136/bcr-2014-204366
  • CASE REPORT

Treatment of myelitis in Behçet's disease with rituximab

  1. Vittorio Martinelli2
  1. 1Department of Neurology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
  2. 2Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
  3. 3Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Maria Josè Messina, messina.mariajose{at}hsr.it
  • Accepted 8 May 2014
  • Published 30 May 2014

Summary

Behçet's disease (BD) is a chronic inflammatory disorder that involves the parenchymal central nervous system (neuro-BD, NBD) approximately in 5–49% of patients, causing lesions rarely located in the spinal cord (SC). We report the first case of NBD-myelitis treated with intravenous rituximab. A 41-year-old man affected by BD presented with mild paraparesis with a miliary involvement and a ‘net-like’ gadolinium enhancement (Gde) of the SC. After a therapeutic attempt with pulsed cyclophosphamide and intravenous methylprednisolone, the clinical and neuroradiological course worsened. A progressive improvement was observed after rituximab administration associated with low doses of oral prednisone. No disease activity was detected and the patient reported no adverse event. After six rituximab cycles, cervical MRI was normal while thoracic MRI showed a slight T2–weighted hyperintensity of D4–D10 spinal tract without Gde. A combined use of rituximab and oral steroids resulted in a long-term suppression of NBD activity without any safety concern.

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