CLINICAL CASES IN MS – CASE 2: A FIREFIGHTER WITH TRANSVERSE MYELITIS

 

Jim is a 26-year-old firefighter who presents with an episode of mild leg weakness, sensory level at T6 and moderate bladder symptoms.

At presentation his EDSS score is 3.0, with leg weakness, spasticity and sensory changes. Baseline brain MRI reveals several (10) lesions including brain and brainstem. Spinal MRI shows a gadolinium-enhancing lesion at T2, and another lesion which does not enhance at C3.

He is treated with steroids with a good response. Serum is negative for anti-AQP4 antibodies and anti-MOG antibodies, and CSF is positive for oligoclonal banding. All other preliminary investigations are unremarkable and the MRI looks characteristic for multiple sclerosis.

At 3-month follow-up, Jim still has sensory and bladder symptoms. EDSS score is 2.0 (sensory 2, bowel 1, bladder 1).

Question 1: Do you consider Jim to have aggressive RRMS?

Question 2: What feature in this case do you find most worrisome? (please pick 1)

Question 3: In general, what clinical/radiological finding would be most likely to prompt you to initiate treatment with a higher-efficacy DMT? (please pick 1)

Question 4: What would be your preferred starting therapy for this patient? (please pick 1)

Question 5: Despite counselling, Jim refuses to receive the COVID-19 vaccine. What would be your preferred starting therapy now? (please pick 1)

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