RT Journal Article
SR Electronic
T1 Primary progressive multiple sclerosis to be treated with ocrelizumab: a mistaken case of cobalamin deficiency
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e229080
DO 10.1136/bcr-2018-229080
VO 12
IS 5
A1 Sydney Feldman
A1 Salman Aljarallah
A1 Shiv Saidha
YR 2019
UL http://casereports.bmj.com/content/12/5/e229080.abstract
AB Cobalamin (vitamin B12) deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders. However, MRI changes associated with cobalamin deficiency are typically spinal predominant and distinct from MS-related changes. We report a case of a patient with cobalamin deficiency who was recommended by her primary neurologist to commence treatment with ocrelizumab, a potent anti-CD20 B-cell depleting monoclonal antibody, after being diagnosed with primary progressive MS. However, cervical spine MRI demonstrated changes classical of cobalamin deficiency including ‘inverted V sign’ signal hyperintensity and following parenteral cobalamin supplementation her neurological symptoms quickly and dramatically improved.