This is a case report of someone with MS-associated fulminant tumefactive demyelinating lesion (TDL) with the special feature of delayed humoral or antibody immune response. Plasma exchange* (PE) yielded significant benefit in two consecutive steroid-unresponsive relapses, while signs of a B-cell response within the central nervous system were only present 2 years later at the second relapse. Remission was achieved and sustained thereafter with natalizumab. This case indicates that PE might be a therapeutic option even when the B-cell response is not fully developed. This delay in the development of a humoral or antibody immune response may reflect the step-wise B-cell colonization of the CNS and represent an attractive therapeutic window of opportunity.
"This study suggests that plasma exchange may be more suitable for some MS'ers with severe relapses that others. I wonder if the Lazarus effect (dramatic responses) may be linked to these observations as well?"
Related posts of interest:
31 Oct 2011
Tumefactive multiple sclerosis: an uncommon diagnostic challenge. J Chiropr Med. 2011 Mar;10(1):29-35. OBJECTIVE: A case report describes a rare presentation of MS that was initially diagnosed as a peripheral nerve ...
27 Aug 2011
It typically occurs in the form of a single large demyelinating lesion that can be indistinguishable from a brain tumor (see figure below; taken from radiopaedia). You may see the term tumefactive (tumour-like) used to describe ...
Additional reading: plasma exchange