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We report a 62-year-old man with a relapsing-remitting phenotype characteristic of early adulthood multiple sclerosis (MS). Onset with sequential, but rapidly remitting episodes of optic neuritis, transverse myelitis, and a brainstem syndrome followed autologous stem cell transplant (SCT) for plasma cell leukemia. This occurrence in a compound heterozygote for 2 MS-associated class II major histocompatibility haplotypes further implicates immune dysregulation in the etiopathogenesis of MS.
Case report.
A 62-year-old northern European man, without previous neurologic dysfunction, presented with weight loss, malaise, and thoracic back pain. Investigations revealed plasma cells in the peripheral blood, an immunoglobulin G (IgG) κ paraprotein of 50.7 g/L−1 with associated immunoparesis, and β2 microglobulin of 85.9 mg/L−1. Serum calcium was 3.1 mmol and there were lytic lesions and associated collapse of multiple thoracic vertebrae. Stage III plasma cell leukemia was diagnosed. He underwent 5 cycles of cytarabine/thalidomide/danarubicin chemotherapy and, 5 months after diagnosis, an autologous SCT with reinfusion of CD34+ stem cells following marrow ablation with melphalan. Within 6 months, he was in remission with an undetectable paraprotein and normal blood indices.
Eight months following SCT, he developed isolated right retroorbital pain with central visual loss reaching a nadir at 1 week. …
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