We report two cases of neuromyelitis optica spectrum disorder (NMOSD) who were misdiagnosed as multiple sclerosis (MS) and developed catastrophic relapses following initiation of dimethyl fumarate. Both patients developed a severe myelitis extending from the cervical cord to the medulla with significant cord swelling, resulting in complete quadriplegia and respiratory difficulties, in addition to severe bilateral visual loss in one patient. It is of note that both catastrophic relapses occurred 2 and 3 months following initiation of dimethyl fumarate.
WingerchukDBanwellBBennettJ. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology2015; 85: 177–189.
2.
HarmelJRingelsteinMIngwersenJ. Interferon−β−related tumefactive brain lesion in a Caucasian patient with neuromyelitis optica and clinical stabilization with tocilizumab. BMC Neurol2014; 14: 247–251.
ShimizuYYokoyamaKMisuT. Development of extensive brain lesions following interferon beta therapy in relapsing neuromyelitis optica and longitudinally extensive myelitis. J Neurol2008; 255: 305–307.
5.
KitleyJEvangelouNKukerW. Catastrophic brain relapse in seronegative NMO after a single dose of natalizumab. J Neurol Sci2014; 339: 223–225.
6.
LeeDHLaemmerAWaschbischA. Neuromyelitis optica presenting with relapses under treatment with natalizumab: A case report. J Med Case Rep2014; 8: 155–157.
7.
JacobAHutchinsonMElsoneL. Does natalizumab therapy worsen neuromyelitis optica?Neurology2012; 79: 1065–1066.
8.
MinJHKimBLeeK.Development of extensive brain lesions following fingolimod (FTY720) treatment in a patient with neuromyelitis optica spectrum disorder. Mult Scler2012; 18(1): 113–115.
9.
IzakiSNarukawaSKubotaA. A case of neuromyelitis optica spectrum disorder developing a fulminant course with multiple white-matter lesions following fingolimod treatment. Clin Neurol2013; 53: 513–517 (in Japanese).
10.
SchillingGGoelzSLinkerR. Fumaric acid esters are effective in chronic experimental autoimmune encephalomyelitis and suppress macrophage infiltration. Clin Exp Immunol2006; 145: 101–107.
