A 32-year-old man with tumefactive multiple sclerosis presented with an early onset of escalating gait unsteadiness, lower limb weakness, and four-day-long numbness. There was no preceding fever or associated trauma, neck pain or back pain. In the past, there were episodes of imbalance, dizziness, urinary urgency and incontinence. The neurological examination of right arms and both legs weakness stood with sensory level at T10. As per contrast-enhanced MRI of the brain, a massive tumefactive demyelination with several demyelinating lesions in the brain, consistent with a diagnosis of multiple sclerosis. Cerebrospinal fluid oligoclonal bands were positive and IgG index was high. When there were acute relapses, a 5-day course of intravenous methylprednisolone 1 gm, after which he started improving gradually but partially.
Results
c) Cladribine 10mg
Cladribine selectively reduces circulating B and T lymphocytes. It has sustained action prolonged immune reconstitution properties. Cladribine increases the levels of anti-inflammatory cytokines and penetrates the blood-brain barrier. It is known to rapidly reduce the size of tumefactive demyelinating lesions in multiple sclerosis with a short course providing effective suppression of disease activity. As the patient was having highly active multiple sclerosis with tumefactive demyelination, use of cladribine may result in clinical and radiological effect.
